Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. Key Details:
Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. Key Details:
Medical Review Nurse (RN) Remote position, however, candidates must reside in the State of TX or State of IL This position is a contract for about 9 months. Pay: $41/hour RN working in the insurance or managed
Job Title This position is fully remote, however, you must reside in the State of Texas. The position is a contract for about 6 months. RN working in the insurance or managed care industry using medically
Ascension Texas Utilization Management Department (Fully Remote) Provides health care services regarding admissions, case management, discharge planning and utilization review. Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy
Remote DUR Pharmacist Safe & Cost-Effective Medication Use Work From Home Analyze medication use patterns, apply clinical guidelines, and collaborate with providers all from home. This remote Drug Utilization Review Pharmacist role is ideal for pharmacists who enjoy
Company Description WNS, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across 10 industries, including Banking and Financial Services, Healthcare, Insurance, Shipping and Logistics, and Travel
Position Purpose: Performs concurrent reviews, including determining members overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate
Anticipated End Date:2026-09-21 Position Title:Utilization Management Representative II Job Description: Utilization Management Representative II Location: This role requires associates to work from the posted locations full-time, enabling consistent face-to-face collaboration, teamwork, and direct engagement. This policy promotes an
Type of Requisition:Regular Clearance Level Must Currently Possess:None Clearance Level Must Be Able to Obtain:None Public Trust/Other Required:MBI (T2) Job Family:Administration Job Qualifications: Skills:Clinical Documentation, Documentation Review, Medical Billing and Coding, Medical Coding, Medical Documentation Certifications:None Experience:5
Medical Director For Utilization Management WellMed, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization that is changing the
Medical Director For Utilization Management WellMed, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization that is changing the
Medical Director For Utilization Management WellMed, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization that is changing the
Medical Director Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people
Medical Director For Utilization Management WellMed, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization that is changing the
Medical Director For Utilization Management WellMed, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization that is changing the
Medical Director For Utilization Management WellMed, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization that is changing the
Medical Director Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people
Job Type: Full-time Pay: $105,000-$110,000 per year plus up to $32,000 in yearly bonuses Job description: Job Summary NO OASIS REVIEW! We are seeking a qualified and experienced Registered Nurse Clinical Manager to lead and support the
Position Purpose: Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective