preferred Utilization management experience preferred Prior experience working for a health insurance company... dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2...
Required Certifications/Licensure: Advanced Practice Registered Nurse in South Carolina (Certified Registered Nurse Anesthetist...); Certification by the American Association of Nurse Anesthetists; RN licensed in the state of South Carolina; Current BLS, ACLS...
as Medical Reviewer I, you will perform medical reviews using established criteria sets and/or performs utilization management... protocol sets or clinical guidelines and provide support and review of medical claims and utilization practices...
protocol sets or clinical guidelines and provide support and review of medical claims and utilization practices... as assigned by Management. To Qualify for This Position, You’ll Need: Associates in a job-related field. Graduate...
Education: Bachelor's degree- Nursing. Preferred Work Experience: 7 years-healthcare program management, utilization review... to service requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge...
Quality Management - Acute Full Time Day Shift 8-430 Consistently named best hospital, Lexington Medical Center... in quality or utilization review. Substitutable Education & Experience (Optional): None. Required Certifications/Licensure...
Description : CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse... Medical Case Management to individuals through in person and telephonic communications with the patient, physician...
Registered Nurse (RN) license required. Must be in good standing. URAC-recognized certification in case management (CCM, CDMS... Registered Nurse (APRN), Nurse Practitioner, Case Management, Case Manager, Home Healthcare, Clinical Case Management, Hospital...
. Provide office education and awareness during the entire access process which may include formulary coverage/utilization... management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution...
utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical. Required License/Certificate... management program interventions. · Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge...
Quality Management - Acute Full Time Day Shift 8-430p Consistently named best hospital, Lexington Medical Center... in quality or utilization review. Substitutable Education & Experience (Optional): None. Required Certifications/Licensure...
Lexington Surgery - Acute Care ( Advance Practice Provider: Nurse Practitioner/Physician Assistant) Full Time PM... will primarily include follow-ups for post-operative patients and oncology surveillance visits. Minimum Qualifications Nurse...
of experience as a registered nurse, including at least 2 years of utilization review, quality assurance, or case management...Quality Management - Acute Full Time Day Shift 8a-430p Mon-Fri Consistently named best hospital, Lexington Medical...
dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2... utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical. Required License/Certificate...