- Novo Nordisk Inc. (Walnut Creek, CA)
- …other field-based employees (eg, DBMs, DCSs, Market Access Team, Diabetes Educators, Medical Liaisons) covering the same geographic areas. The Specialty Field Sales ... and unique insights Leverages superior understanding of complexities within the targeted physician customer base in order to maximize performance Applies high level… more
- Merck & Co. (Rahway, NJ)
- …to characterize disease burden and epidemiology, treatment patterns, healthcare resource utilization and costs, physician and patient satisfaction surveys, ... The incumbent is expected to work cross-functionally with clinical development, medical affairs, biostatistics, market access, commercial and country affiliates. The… more
- Merck & Co. (North Wales, PA)
- …to characterize disease burden and epidemiology, treatment patterns, health-care resource utilization and costs, physician and patient satisfaction surveys, ... Outcomes Research, position resides in the V&I organization, which includes Global Medical and Scientific Affairs as well as Outcomes Research, and will support… more
- UPMC (Pittsburgh, PA)
- The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... Health Plan members. This fully remote role will be responsible for assuring physician commitment and delivery of comprehensive high quality health care to UPMC… more
- Sutter Health (Sacramento, CA)
- …expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical necessity, documentation best practices, level ... Health Internal Physician Advisor Services (IPAS). The physician Advisor will work closely with the medical... physician Advisor will work closely with the medical staff, including house staff, and all utilization… more
- Hackensack Meridian Health (Hackensack, NJ)
- The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical ... records for the patient population and Hackensack University Medical Center. These include but are not limited to... Center. These include but are not limited to utilization review, hospital reimbursement, clinical compliance, case management, and… more
- Commonwealth Care Alliance (Boston, MA)
- …Alli-Physicians Group **Position Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review, the Utilization Review ... state, and local regulatory guidelines. + Serve as the lead for CCA's Utilization Review functions working closely with other medical management team members.… more
- The County of Los Angeles (Los Angeles, CA)
- …staff training is needed, and to make recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to ... Medi-Cal reimbursement. + Analyzes cases for referral to the physician advisor to ensure that the admission or continued...I:One year of experience performing the duties of a Utilization Review Nurse* or Medical Service Coordinator,… more
- Guthrie (Troy, PA)
- …coding, medical record or chart auditing, and experience in utilization management processes preferred. Knowledge of computer applications (such as Microsoft ... revenue cycle process, coordinates as necessary with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital… more
- UPMC (Pittsburgh, PA)
- The Regional Medical Director, CC/DP and Utilization Review, provides clinical and management leadership across multiple hospitals within the region. This role ... focuses on improving patient flow, resource utilization , and length of stay (LOS) strategic...closely with local hospital VPMAs and presidents. The Regional Medical Director will have direct reports, including Physician… more
- The County of Los Angeles (Los Angeles, CA)
- … direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one ... hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty...utilization review standard. Under the direction of a physician member of the Utilization Review Committee,… more
- UNC Health Care (Morrisville, NC)
- …Executive Director works closely with leaders from various departments-case management, physician advisors, revenue cycle, medical staff, nursing, and ... Guide physician engagement initiatives by developing training programs for physician advisors and advocating for evidence-based resource utilization 3.… more
- Adecco US, Inc. (Minneapolis, MN)
- …Adecco?** * Weekly Pay * 401(k) Plan * Skills Training * Excellent medical , dental, and vision benefits **IMPORTANT:** This ** Utilization Management Nurse** job ... Adecco Healthcare & Life Sciences is hiring ** Utilization Management Nurses** ! This role is work...proposed hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiency in accordance with CMS coverage… more
- Beth Israel Lahey Health (Burlington, MA)
- …Management & review, HIM, Coding & Billing. Close collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. ... to Utilization Review. + Well-developed knowledge and skills in medical necessity, and patient status determination. + Effective verbal communication, problem… more
- AdventHealth (Glendale Heights, IL)
- …basis to assure resolution of pending denials, which have been referred to the physician for peer-to-peer review with the Medical Director of the insurance ... 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use...standards. When screening criteria does not align with the physician order or a status conflict is indicated, the… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical necessity and...this position is able to cover a multitude of utilization review functions through point of entry, observation progression… more
- UNC Health Care (Chapel Hill, NC)
- …the Utilization Manager is responsible for revenue protection by reconciling physician orders, bed billing type, and medical necessity. This may include ... Advisor as necessary to resolve barriers through appropriate administrative and medical channels. 4. Utilization Outcomes Management - Monitors and guides… more
- Houston Methodist (Houston, TX)
- …ESSENTIAL FUNCTIONS** + Participates in quality improvement activities as stewards for resource utilization as it pertains to medical necessity and level of ... At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed...(RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and… more
- Tenet Healthcare (Detroit, MI)
- …integrates national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention ... Securing and documenting authorization for services from payors Performing accurate medical necessity screening and timely submission for Physician Advisor… more
- Alameda Health System (Oakland, CA)
- … utilization . This role supports patient care coordination, fosters physician collaboration, and aligns with organizational objectives while adapting to ad ... Director, Utilization Management + Oakland, CA + Highland General...utilization of healthcare services, including appropriateness, efficiency, and medical necessity of treatments and procedures. + Analyze data… more
