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We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help...

A company is looking for a Utilization Management Director - RN Required - Remote.Key ResponsibilitiesOversee day-to-day operations of the Utilization Management Department to ensure compliance with payer requirements and regulatory...

A company is looking for a Utilization Management RN to ensure efficient healthcare resource use while promoting quality patient care.Key ResponsibilitiesCoordinate with healthcare teams to assess and monitor the delivery of healthcare...

A company is looking for a Clinical Review Nurse - Correspondence.Key ResponsibilitiesDrafts correspondence letters based on clinical review outcomes in accordance with NCQA standardsInvestigates denials and provides supplemental information to...

A company is looking for a Utilization Review Clinician - Behavioral Health.Key ResponsibilitiesEvaluate member's treatment for mental health and substance abuse to ensure medical appropriatenessPerform prior authorization reviews and concurrent...

A company is looking for a Utilization Management Nurse.Key ResponsibilitiesCoordinate and facilitate correct identification of patient statusConduct concurrent and retrospective reviews and support the medical necessity denial and appeal...