Key Responsibilities:
Review prior authorization requests for medical necessity and collaborate with Medical Directors as needed
Utilize evidence-based criteria and governmental policies for medical necessity reviews and manage claims disputes
Coordinate transitions of care and referrals to Care
Key Responsibilities
Review and document prior authorization and appeals requests, along with member case history
Analyze trends and recommend revisions to medical policies and utilization management based on case reviews
Interface with members, providers, and internal departments to ensure effe
JOIN TEAM TRILOGY: At Trilogy, you'll experience a caring, supportive community that values each team member. We prioritize meaningful relationships, genuine teamwork, and continuous growth. With the stability of...
JOIN TEAM TRILOGY: At Trilogy, you'll experience a caring, supportive community that values each team member. We prioritize meaningful relationships, genuine teamwork, and continuous growth. With the stability of...
Travel Nurse, Case Manager, Utilization Review, Healthcare, Nursing Jobs, Travel Nursing, Medical Solutions, Patient Care, Flexible Work, Benefits. As a Travel Nurse RN Case Manager specializing in Utilization Review, you will provide high-quality care while having the flexibility of travel nursing
Overview: Empower Healing & Inspire Hope as a Registered Nurse ...
By clicking the "Apply" button, I understand that my employment application process with Takeda will commence and that the information I provide in my application will be processed in line with Takeda's Privacy Notice and Terms of Use. I further...
Hello Doctor, I consult Hospitals nationwide seeking ENT Locums...
Exciting Opportunity: School Speech-Language Pathologist - SLP in the Indianapolis, IN area! PediaStaff is a trusted leader in pediatric therapy and educational staffing solutions, connecting passionate...
Travel Nurse, Utilization Review, Case Manager, Healthcare, Registered Nurse, Travel Nursing Jobs, Medical Solutions, Nursing Jobs, Telehealth, Patient Care. Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Indianapolis, Indiana. Travel Nurs
Build your own schedule. Take control of your career. Looking for RN jobs that fit your life? If you're tired of having no control over your schedule or just want to earn more money, PRN shifts could be what you're looking for! ShiftKey...
JOIN TEAM TRILOGY: At Trilogy, you'll experience a caring, supportive community that values each team member. We prioritize meaningful relationships, genuine teamwork, and continuous growth. With the stability of...
Exciting Opportunity: School Speech-Language Pathologist - SLP in the Indianapolis, IN area! PediaStaff is a trusted leader in pediatric therapy and educational staffing solutions, connecting passionate...
Why Deliver with DoorDash? DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day. As a Dasher, you'll stay busy with a variety...
By clicking the "Apply" button, I understand that my employment application process with Takeda will commence and that the information I provide in my application will be processed in line with Takeda's Privacy Notice and Terms of Use. I further...
JOIN TEAM TRILOGY: At Trilogy, you'll experience a caring, supportive community that values each team member. We prioritize meaningful relationships, genuine teamwork, and continuous growth. With the stability of...
JOIN TEAM TRILOGY: At Trilogy, you'll experience a caring, supportive community that values each team member. We prioritize meaningful relationships, genuine teamwork, and continuous growth. With the stability of...
Why Deliver with DoorDash? DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day. As a Dasher, you'll stay busy with a variety...