Utilization Management Coordinator

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

Active BCBA (Board Certified Behavior Analyst) certification and state licensure (3+ years of ABA (Applied Behavior Analysis) clinical experience - Required Experience creating and supervising ABA (Applied Behavior Analysis) treatment plans Direct patient care background (dealing with children with Behavior / Autism issues) Utilization Management or insurance review experience strongly preferred Comfortable reviewing medical necessity and authorization requests Familiar with managed care and pay

Hi, Hope youre doing well!! Please find the requirement below. If you find yourself comfortable with the requirement please reply back with your updated resume or call me back at Position:Utilization Management Specialist - Behavioral Health Location:Remote(Must reside in the DMV area Maryland, Virginia, or Washington, DC) Duration: 6+ Months Visa: Client won't be able to sponsor any visa LinkedIN ID We are seeking experiencedBoard Certified Behavior Analysts (BCBAs)to join our cl

Role: Clinical Care Advance (CCA) Configuration Analyst Experience: 5 12 Years Role Summary We are seeking experienced TriZetto Clinical Care Advance (CCA) Configuration experts to support a large-scale Utilization Management (UM) and Prior Authorization (PA) modernization program for a leading US Healthcare payer. The role involves hands-on configuration of CCA workflows, business rules, authorizations, correspondence, and integrations. Key Responsibilities Configure CCA workflows and busine