Hybrid Schedule - 3 days remote and 2 on-site (Tues/Thurs). M-F 8am - 5pm. Position Overview* The Utilization Management Specialist plays a critical role within the Quality Management department, serving as the last line of defense for claims that have been denied. This position is responsible for researching denied claims, gathering necessary information, and facilitating resubmission to Health Plans. The ideal candidate will possess strong verb...
HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 member...
FL based ONLY: Must be FL resident. Join the Cleveland Clinic team where you will work alongside passionate caregivers and provide patient-first healthcare. Here, you will receive endless support and appreciation while building a rewarding career with one of the most respected healthcare organizations in the world. As a Utilization Management Specialist, you will perform UM activities, such as admission, concurrent, retrospective chart and clinic...
Position Purpose. This position is responsible for promoting appropriate, effective and efficient use of health care resources via prior authorization review. The scope of this position includes using criteria sets and policy and procedures to review clinical care and treatment plans and out of network referrals to determine appropriateness. Essential Position Functions. Applies clinical experience, health plan benefit structure, health managemen...
Position Purpose. This position is responsible for promoting appropriate, effective and efficient use of health care resources via prior authorization review. The scope of this position includes using criteria sets and policy and procedures to review clinical care and treatment plans and out of network referrals to determine appropriateness. Essential Position Functions. Applies clinical experience, health plan benefit structure, health managemen...
