Utilization Review jobs in Providence, RI

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Nurse Reviewer
Blue Cross Blue Shield of Rhode Island 11 reviews - Providence, RI
Professional Utilization Review certification... Understanding of utilization review techniques including all aspects of the medical review function...
Sponsored by Blue Cross Blue Shield of Rhode Island - 2 days ago
Nurse Case Manager
Blackstone Valley Community Healthcare - Pawtucket, RI
Performs overall utilization management, resource... care plan o Obtain quality indicators for reporting o Review quality outcomes data with health care team o...
Easily apply
Sponsored by Blackstone Valley Community Healthcare - 30 days ago

Nurse Reviewer

Blue Cross Blue Shield of Rhode Island 11 reviews - Providence, RI
Three to five years acute medical or clinical experience or experience in utilization reviewed. Preferred Education, Additional Qualifications and Experience:....
2 days ago - save job - email - more...

Onsite RN Nurse Case Manager, Providence RI

UnitedHealth Group 1,487 reviews - Providence, RI
Experience in utilization review, concurrent review and/or risk management. Strong organizational skills and multitasking abilities will be keys to success....
16 days ago - save job - email - more...

Telephonic Utilization Management RN - Work from Home

UnitedHealth Group 1,487 reviews - Warwick, RI
Perform utilization management, utilization review, or concurrent review (telephonic inpatient care management)....
17 days ago - save job - email - more...

Clinical Care Managers

PsychPros - Providence, RI
of the Manager Clinical Services, or Supervisor Care Management, and in conjunction with other members of the clinical team, provide or review intakes,...
3 days ago - save job - email - more...

Insurance - Health Care Fraud Analyst

C2 Solutions Group, Inc. - Warwick, RI
The surveillance and utilization review analyst applies clinical knowledge to Medicaid claim data to identify possible issues of fraud or abuse of Medicaid...
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21 days ago - save job - email - more...

Clinical Quality Management Analyst

Blue Cross Blue Shield of Rhode Island 11 reviews - Providence, RI
Conduct reviews for quality of care complaints;. provider site visits and medical record reviews for credentialing, on-going monitoring, and data collection;....
9 days ago - save job - email - more...

Production & Planning Operations Manager

BAE Systems 1,048 reviews - Middletown, RI
-Act as liaison with Engineering, Purchasing, Production Control and other applicable departments to resolve any concerns and to achieve optimum utilization of...
1 day ago - save job - email - more...

RN Case Manager (SCO) - Raynham (Southeast Region)

Fallon Community Health Plan 23 reviews - Raynham, MA
Reviews Enrollee enrollment data, claims data, urgent and emergency room utilization, acute/skilled nursing inpatient census, referrals from Primary Care Team...
12 hours ago - save job - email - more...

Utilization Review Clinician

Beacon Health Strategies, LLC 9 reviews - Providence, RI
Review Clinician performs utilization review and initial authorization determination of mental health and substance use services provided in inpatient,...
30+ days ago - save job - email - more...

Registered Nurse w/ Medicaid Exp.

Logistics Integration Solutions - Warwick, RI
The surveillance and utilization review analyst applies clinical knowledge to Medicaid claim data to identify possible issues of fraud or abuse of Medicaid...
Easily apply
21 hours ago - save job - email - more...
Telephonic Utilization Management RN - Work from Home
UnitedHealth Group 1,487 reviews - Warwick, RI
Perform utilization management, utilization review, or concurrent review (telephonic inpatient care... planning and/or utilization review 2+ years...
Sponsored by UnitedHealth Group - 17 days ago
Field Care Advocate - Rhode Island - Work from Home
UnitedHealth Group 1,487 reviews - Providence, RI
planning and/or chart review Managed care experience... health, mental health, Case Management, Utilization Review, Utilization Management, telephonic, work from...
Sponsored by UnitedHealth Group - 28 days ago
Clinical Quality Management Analyst
Blue Cross Blue Shield of Rhode Island 11 reviews - Providence, RI
Conduct reviews for quality of care complaints; provider site visits and medical record reviews for... quality management, utilization management and case...
Sponsored by Blue Cross Blue Shield of Rhode Island - 9 days ago

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Company with Utilization Review jobs
1,487 reviews
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