Utilization Management Nurse Specialist

Utilization Review Specialist (Government, RN, LPN)Introduction:Elite Technical is seeking a Maryland or Nurse Licensure Compact (NLC) certified (RN or LPN) Utilization Review Specialist to support our customer, a major Healthcare payor in the Maryland area. We are seeking candidates who have 5 years of experience as a Nurse, 2 years in a Utilization Management role, and have an understanding of Milliman Care Guidelines (MCG) and Guidingcare/Healthedge. Responsibilities:The Utilization Review Sp

Medical Director (Utilization Management) - Remote, USLocation: Remote (US) Employment Type: Contract-to-Hire Schedule: Full-time, 40 hours/week <>About the RoleWe are seeking an experienced Medical Director to join a physician-led team responsible for utilization management and clinical review activities for a health insurance organization. This role focuses on evaluating medical necessity, appropriateness of care, appeals, and complex case reviews while ensuring compliance with applicable regu

Title: Medical Director Shift timings: 8-5 EST M-F Duration: 12 months Location: The role is 100% remote, but candidates need to be from an approved conversion State (Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.) JOB DESCRIPTION The application of a Medical Dir

Job Title: Physician ED Claims Reviewer Location : 100% Remote Role USA Duration : 6+ Months Contract or Fulltime Job Description: Berribot Test Required After Submitting the profile Note: Check with candidates if they are comfortable for Beribot interview Required skills: Physician with an active US licensed with experience in with medical coding (CPT/HCPCS) and managed care to conduct clinical review of claims and UM authorization requests for clinical necessity. Minimum of recent (last 2-3 y