Utilization review nurse jobs in St Louis, MO

The incumbent must be an excellent communicator, collaborative and possess the ability to make sound, time sensitive decisions.Execute quality review and closure of executed production batch..

partners with the tools needed to help promote brand enhancing advertising and fund utilization.. What you will do. Review marketing materials against an established set of guidelines and brand..

Tracks employee onboarding to ensure successful completion of training plans and new hire reviews. Oversees annual performance review and merit increase process. Collaborates with CEO..

Medical Review Team POSITION LOCATIONThis position is available to Virginia residents as Richmond or.. What you bringActive Registered Nurse (RN) licensure At least two years experience working in a role..

and medical professionals and expert psychiatrists and nurses deliver care that never stops.. Serves on various internal and external committees, such as Utilization Review, as assigned..

Reviews medical files and provides recommendations for utilization review, chart reviews, medical.. nurses and health care professionals. Medical direction shall also be provided consistent with the..

Service Reliability. Quality Review and Audit Lead Analyst. PBM (High Band ) POSITION SUMMARY The Quality Review and Audit Lead Analyst is responsible for facilitating the analysis, research..

Service Reliability. Quality Review and Audit Lead Analyst. PBM (High Band ) POSITION SUMMARY The.. Healthcare acumen. Corrective Action Preventive Action Management Responsibilities. Review, analyze, and..

Coordinates maintenance of the facility locations and coordinates utilization of internal and external.. Ensures treatment notes are thoroughly written and approved. Regularly review and monitor written..

Aids utilization management team to document authorization requests and obtain accurate and timely.. Review faxes and process them into electronic medical record system. Accept phone calls from providers..

Thorough knowledge of customer service, utilization review or claims processing practices in a managed.. Identify members without a PCP and refer to Member ServiceAssist in monitoring utilization of medical..

Act as point of contact for all Salesforce database activities. Heavy utilization of Salesforce database.. initiating province wide changes updates, run and review catalog proofs, verify catalog statistics..

The CM Service is comprised of three departments. Case Management, Utilization Management, and Social.. The Service employs registered nurses, social workers, a license practical nurse, a customer service..

Wellness initiatives, plan design, plan utilization reporting, eligibility files, the Hub and Internet.. develop and establish benchmarksOutline service expectations and review vendor performance to ensure..

The CM I performs ongoing utilization review and acts as a liaison to the payor while assuring that cost effective treatment is provided by the team. The case manager assures that regulations..

Leads develop of interim and final solutions. Provides design phase subject matter expertise by supporting Integrated Product Teams (IPT) and participating in design reviews. Represents the..

Duties may include. review and evaluation of patient drug medical history, providing drug therapy.. Participates in drug utilization evaluations (DUEs), analyzes trends and evaluates data to be..