- Crouse Hospital (Syracuse, NY)
- … staff and/or other health care professionals in accordance with the hospitals Utilization Review guidelines to ensure efficient utilization of health ... Conducts clinical review on cases referred by case management...to practice medicine. Preferred: Additional education in quality and utilization management through continuing medical education programs… more
- Intermountain Health (Las Vegas, NV)
- …position interacts with UM physician and operational leadership. As the UM Physician Reviewer , you are responsible, in partnership with the Sr. Director of ... Leadership. Job Profile: + Trains and educates on medical review activities pertaining to utilization review...criteria, and state, local, or federal guidelines relating to utilization management . + Demonstrated knowledge of case… more
- MetroHealth (Cleveland, OH)
- …is consistent with contractual agreements. Serves as a clinical resource to the physician group and Utilization Management Specialists. Upholds the mission, ... - Care Coordination, plans, coordinates, and evaluates all activities impacting utilization review (eg, the centralized referral/authorization area specifically… more
- CommonSpirit Health (Houston, TX)
- …Candidates licensed in other states will be considered for future openings.** As the Utilization Management Physician Advisor II, the Physician Advisor ... staff ensuring that the system is optimized for effective physician use. The PA helps facilitate training for the...Steering Committee + Extended Length of Stay Rounds + Utilization Review Committee + Care Management… more
- Highland Hospital (Rochester, NY)
- …Physician **Department/Cost Center:** 776 - Quality Assurance **Job Description:** The Utilization Management Physician Advisor is responsible for ... serving the hospital through teaching, consulting, and advising the utilization management department. The Physician ...RN will refer cases to the UM PA for review of inpatient, observation or alternative level of care… more
- CommonSpirit Health (Englewood, CO)
- …of four 10-hour shifts per week, or five 8-hour shifts per week.** As the Utilization Management Physician Advisor (PA), the PA conducts clinical case ... of health care services. The PA communicates remotely with case and utilization management to discuss selected cases and make recommendations regarding level… more
- CommonSpirit Health (Phoenix, AZ)
- …and out in the community. **Responsibilities** This is a remote position. As the Utilization Management Physician Advisor (PA), the PA conducts clinical case ... of health care services. The PA communicates remotely with case and utilization management to discuss selected cases and make recommendations regarding level… more
- Beth Israel Lahey Health (Burlington, MA)
- …resource allocation - Serves as physician expert and provide support to utilization review team regarding utilization decisions pertaining to commercial ... necessity recommendations, as requested Policy Setting Responsibilities Responsible for utilization review and medical necessity recommendations, as requested… more
- Guthrie (Sayre, PA)
- Position Summary: The Utilization Management (UM) Reviewer , in collaboration with other internal and external offices, payors, and providers and staff, is ... responsible for the coordinates Utilization Management (UM) processes and requirements for...prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures authorization as appropriate… more
- Kepro (Los Angeles, CA)
- …to being a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team. Job Summary As a ... Utilization Clinical Reviewer , you'll harness your expertise...the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process in alignment with the esteemed California Mental… more
- Prime Therapeutics (Columbus, OH)
- …- Oncology - REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do ... needed or required. **Job Description** + Directs daily involvement in the following utilization management functions: + Reviews all cases in which clinical… more
- Evolent Health (Columbus, OH)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer , Interventional Pain Management , you will be a key ... Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Kepro (Los Angeles, CA)
- …for health solutions in the public sector. Position Overview As a Utilization Reviewer , you involves reviewing medical records against appropriate criteria ... ensures the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process with the California Mental Health Services Authority (CalMHSA).… more
- Evolent Health (Columbus, OH)
- …As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Kepro (Lombard, IL)
- …vital partner for health solutions in the public sector. Acentra seeks a Psychiatrist Physician Reviewer (Illinois Remote, PRN) to join our growing team. Job ... Summary: The Psychiatrist Physician Reviewer will provide principal leadership and...and clinical expertise to operations relating to the peer review process, utilization review activities,… more
- Elevance Health (Rancho Cordova, CA)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... **Nurse Reviewer I** **Location: The ideal candidate for this...required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- Elevance Health (Palo Alto, CA)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... **Nurse Reviewer I** **Location:** Within 50 miles of a...required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-10 + Previous … more
- Elevance Health (San Juan, PR)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... from one of the 50 states of the United States. + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including… more
- Ellis Medicine (Schenectady, NY)
- …include Director of Quality and Risk, Director of Family Medicine Residency Program, Physician Advisor Utilization Management , and System Wide Chiefs. The ... accordance with Hospital Policy and Procedure, and oversight of physician contract management functions. + Serves as...the budgets of the Clinical Departments. + Provides contractual review for and reviews performance of all physicians who… more
- AdventHealth (Maitland, FL)
- …managed care payers. The Medical Director is responsible for providing physician review of utilization , claims management , and quality assurance related ... need.Collaborates with Senior Medical Officers with contracted managed care payers regarding utilization review management activities and maintain a positive… more