Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and i...
Description. . Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a. Utilization Review Nurse (UR Nurse). you’ll play an important role in helping us offer customized, self-funded insurance options to our clients and members. . The UR Nurse is responsible for reviewing clinical information to determine the medical necessity, appropriateness, and efficiency of healthcare services, procedures,...
Job Details. Job Title: RN Case Management Analyst [. Utilization Management]. Location: 100% Remote. Duration: 06 Months (Possible Extension). Job Summary. This is a remote position. this role is 8am-5pm M-F and manager prefers compact RN license. Nurse Case Management Senior Analyst. Delivers specific delegated tasks assigned by a supervisor in the Nurse Case Management job family. Plans, implements, and evaluates appropriate health care servic...
Description. Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a. Utilization Review Nurse (UR Nurse). you’ll play an important role in helping us offer customized, self-funded insurance options to our clients and members. The UR Nurse is responsible for reviewing clinical information to determine the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and...
Description. Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a. Utilization Review Nurse (UR Nurse). you’ll play an important role in helping us offer customized, self-funded insurance options to our clients and members. The UR Nurse is responsible for reviewing clinical information to determine the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and...
Job Description – RN Utilization Review (Remote). We are hiring an experienced. RN for a Utilization Review role. This is a. 13-week contract. fully remote, supporting multiple facilities and working in. Pacific Standard Time. . Key Responsibilities. Perform utilization review, concurrent and retrospective reviews. Assess medical necessity using. InterQual. (required). Complete prior authorizations, admission reviews, denials, and audits. Documen...
Overview. About us. Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett’s Berkshire Hathaway group – one of the financially strongest organizations in th...
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Nurse Reviewer -Utilization Management / Prior Authorization3-6 Month Contract / Temp to PermCompact License RequiredDetermine medical appropriateness of services following evaluation of medical guidelines applying evidenced-based InterQual® criteria, Medical Policy and benefit determination.Perform utilization review activities, including pre-certification, concurrent and retrospective reviews according to guidelines.Determine medical necessity ...
Nurse Reviewer -Utilization Management / Prior Authorization3-6 Month Contract / Temp to PermCompact License RequiredDetermine medical appropriateness of services following evaluation of medical guidelines applying evidenced-based InterQual® criteria, Medical Policy and benefit determination.Perform utilization review activities, including pre-certification, concurrent and retrospective reviews according to guidelines.Determine medical necessity ...
Utilization Review Nurse. Full-Time - 8A to 4P. WHO WE ARE. In 2004, in an ambitious push to bring hospitality back to the hospital, a small group of top Metro-Detroit surgeons decided to create their own surgical hospital. one that provided patients with the best possible care in a small, easy-to-manage environment that truly embraces the best patient experience. Our highly skilled surgeons and staff play a key role in our success rates and be...
Job description. The UM Nurse manages providers, members, or care manager generated requests for medical services and renders clinical determinations in accordance with Hamaspik Choice policies as well as applicable state and federal regulations. UM Nurse delivers timely notification detailing Hamaspik Choice clinical decisions. Participates in UM review process of claims. Essential Responsibilities. Reviews planned, in process, or completed heal...
