Our Client, a Health Insurance company, is looking for an Utilization Review Specialist for their Baltimore, MD/ Hybrid... location. Responsibilities: Utilizing key principles of utilization management, the Utilization Review Specialist...
as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system... utilization review processes, including management of patient statusing processes and monitoring of medical necessity review...
PURPOSE: Utilizing key principles of utilization management, the Utilization Review Specialist will perform.... Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information...
Location(s): Baltimore, MD Utilizing key principles of utilization management, the Utilization Review Specialist will perform.... Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information...
nursing experience, with experience in a patient care setting and two years performing Utilization Review/Quality Assurance...
. Contacts vendors, insurance companies, and other departments regarding appeal status and utilization review activity...) denials/appeals processing or utilization review; 2) collection or accounts receivable follow up; or 3) tech/medical secretary...
entails both the physical handling of items and the utilization of automated systems employed for the maintenance of corporate..., replenishment, and par level review. Oversees the daily activity related to Asset Inventories in conjunction with management...
management, the Utilization Review Specialist will perform prospective, concurrent and retrospective reviews for authorization... Utilization Review Specialist, will analyze clinical information, contracts, mandates, medical policy, evidence based published...
, storage, and utilization of equipment, materials, and supplies. Establishes and maintains contractual services. · Oversees... with subordinates to review programs, provide feedback, discuss new developments, and exchange information. Minimum Qualifications...
but not limited to: Access Authorization and pre-certification, utilization review and denial management, Care Coordination... of utilization criteria, appeal and review process, and case management system documentation. Develop staff schedule and revises...
by completing Drug Utilization Review and Final Quality Assurance, applicable to state and federal Board of Pharmacy regulations. 2... and when available MTM (Medication Therapy Management), DCS (Diabetes Care Specialist), and all ongoing other programs...