- CoxHealth (Lake Spring, MO)
- …for facilitating timely and accurate physician documentation in the medical record through concurrent chart review . Interdisciplinary communication and ... team regarding proper clinical documentation utilizing approved guidelines. Understand and utilization of ICD-10-CM and PCS coding assignment and follow Official… more
- Prisma Health (Maryville, TN)
- …of care and timely implementation of plan of care in accordance with hospital(s) Utilization Review Plan and CMS regulation. Maintains expert level knowledge of ... timely contacts with insurers to provide clinical information to support physician referrals. In collaboration with physicians, leads the multidisciplinary team… more
- Alameda Health System (Oakland, CA)
- …for patients, improve the quality of patient care and maximize the efficient utilization of physician and hospital resources. Report to departmental leadership ... Emergency Medicine Physician + Oakland, CA + Highland General Hospital...for Alameda Health System, under employment from Alameda Health Medical Group. Services will be on-site at Highland Hospital.… more
- Stanford Health Care (Palo Alto, CA)
- …provides clinical direction and education, works closely with operational and physician leaders, and has oversight of hiring, termination, and professional growth ... Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), or the Physician Assistant (PA) Job Description approved by the Interdisciplinary Practice… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …results-driven **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical directors/ physician reviewers, network physicians, ... to enhance understanding of criteria application, benefit use, and the appeal, External Medical Review (EMR), and Fair Hearing processes + Coordinate: Ensures… more
- Teleflex (Boston, MA)
- …:13056 **Interventional -** The Interventional business unit at Teleflex offers innovative medical devices that are used to diagnose and treat coronary and ... a dynamic, growing team that offers healthcare providers an array of medical technology solutions that make a difference in patients' lives. **Position Summary**… more
- Stanford Health Care (Palo Alto, CA)
- …Provides clinical direction and education, works closely with operational and physician leaders, and has oversight of hiring, termination, and professional growth ... Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), or the Physician Assistant (PA) Job Description approved by the Interdisciplinary Practice… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more
- Stanford Health Care (Palo Alto, CA)
- …and compliance. Areas of responsibility managing a portfolio of contracts covering medical supplies, non- medical supplies, and purchased services with a focus ... for changes in process and operations to include standardization and utilization of resources (supplies, equipment, services, people, etc.). The Category Manager… more
- Battelle Memorial Institute (Oceanside, CA)
- …current notes in the electronic medical records of all patients contacted for review by the managing physician + Routinely staff difficult cases with the ... conducting applied research, consulting with multidisciplinary teams, maintaining detailed medical records, possibly supervising trainees, performing case management, and… more
- Katmai (Fort Carson, CO)
- …procedures, treatments and medications are administered in accordance with (IAW) physician orders, sound nursing judgment and applicable guidelines. + Accurately ... and physical protection of patient information. + Generate and maintain proper medical records on beneficiaries to whom treatment is provided in accordance with… 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… more
- Hackensack Meridian Health (Hackensack, NJ)
- **The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- The County of Los Angeles (Los Angeles, CA)
- …recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the committee of new or ... 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 … more
- The County of Los Angeles (Los Angeles, CA)
- …administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the ... Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician...for and the effective conduct of the system to review patients' medical charts to ascertain the… more
- Houston Methodist (Houston, 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 ...this position is able to cover a multitude of utilization review functions through point of entry,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …professional development specialist to develop standard work and expectations for the utilization review process, including timely medical necessity ... actions to UR Committees, as appropriate * Partners with Physician Advisor to engage in second level review...with payers, as appropriate * May participate in the Utilization Review Committee to present medical… more
- CaroMont Health (Gastonia, NC)
- …MCO, Medicare, or RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of ... medical necessity will be performed and documented in medical review , including daily status update while...NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... provision of quality based patient care focusing on the medical necessity and efficiency of the delivery of such...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Utilization Review Assistant is responsible for taking the data provided to their ... department and using it to communicate necessary information to both the Utilization Review Nurses and insurance companies. Making sure that all necessary… more
