- Novo Nordisk Inc. (Walnut Creek, CA)
- …and unique insights Leverages superior understanding of complexities within the targeted physician customer base in order to maximize performance Applies high level ... appropriate patients that would benefit in order to ensure early trial and utilization Generates advocacy for Novo Nordisk products and services by sharing approved… 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
- 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 ... this position is able to cover a multitude of utilization review functions through point of entry,...process improvements). **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates with the physician and all members of the interprofessional health care… more
- Nuvance Health (Danbury, CT)
- …any issues/denials to department leadership.* 12) Forwards reviews that require secondary physician review to appropriate resource ( Physician Advisor) 13) ... one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the physician...required. Education: ASSOCIATE'S LVL DGRE Required: 3 Years of Utilization Review experience(or a certification ACMA, MCG,… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Hunterdon Health Care System (Flemington, NJ)
- Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure the effective and efficient ... an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the… more
- Alameda Health System (Oakland, CA)
- …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating in ... System Utilization Management SUM Specialist + Oakland,...observation, outpatient). 3. Expeditiously refer cases to the internal/external Physician Advisor for review of requests that… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Catholic Health Initiatives (Omaha, NE)
- …2 hours of a Commonspirit Health Facility Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact ... our patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! As our… more
- Trinity Health (Athens, GA)
- **Employment Type:** Part time **Shift:** **Description:** The Utilization Review (UR) Coordinator works, in collaboration with a multidisciplinary team that ... in denials management and auditing duties as assigned. Participates in the Utilization Review Committee as assigned. Maintains good rapport and cooperative… more
- HCA Healthcare (Henderson, NV)
- …growth, we encourage you to apply for our Consulting Provider Solutions Specialist opening. We promptly review all applications. Highly qualified candidates ... for benefits may vary by location._** We are seeking a(an) Consulting Provider Solutions Specialist for our team to ensure that we continue to provide all patients… more
- HCA Healthcare (San Antonio, TX)
- …and personal growth, we encourage you to apply for our Provider Solution Specialist opening. We promptly review all applications. Highly qualified candidates ... and integrity. We care like family! Jump-start your career as a Provider Solution Specialist today with IT&S - San Antonio Division. **Benefits** IT&S - San Antonio… more
- Mohawk Valley Health System (Utica, NY)
- … regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of...and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides… more
- Baptist Memorial (Memphis, TN)
- …BMHCC. Physician Advisor communication may be necessary to provide further clinical review from the physician perspective as needed in preparation of writing ... Overview Specialist -Denial Mitigation II RN Job Code: 21432 FLSA...clinical meetings, reach out to payer contacts, communicate with physician clinics to obtain additional documentation to support appeal,… more
- Veterans Affairs, Veterans Health Administration (Fayetteville, NC)
- …improvement certification. Current mastery level certifications include: Certified Coding Specialist (CCS),Certified Coding Specialist - Physician -based ... medical data from patient health records in the hospital setting, and/or physician -based settings, such as physician offices, group practices, multi-specialty… more
- HCA Healthcare (Dallas, TX)
- …staff performance evaluations. + Acts as manager in charge as assigned. + Provides review and guidance on physician order sets and other evidenced based ... in daily multidisciplinary and bedside rounds + Completes drug utilization reviews to promote rational drug therapy and implement...we encourage you to apply for our Clinical Pharmacist Specialist BMT opening. We promptly review all… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Enhanced Care Management Clinical Specialist II Job Category: Clinical Department: Care Management...Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM),… more
- HCA Healthcare (Richmond, VA)
- …acute inpatient rehabilitation services prior to returning home. The Clinical Rehabilitation Specialist will review these patients daily until they have strong ... clinical evidence to request a physician order for a formal pre-admission assessment for acute...we encourage you to apply for our Clinical Rehab Specialist PRN opening. We review all applications.… more
- Abbott (Plano, TX)
- …required clinical information for authorizations. + Work with respective carrier's utilization review department to obtain appropriate authorizations. + Assist ... insurance, Worker's Compensation and Medicare guidelines pertaining toProspective and Retrospective Utilization Review . Some experience in medical deviceor DME… more
- HCA Healthcare (Nashville, TN)
- …treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile ... on face to face or telemedicine assessment completed and physician consult. + Provides a thorough clinical review...patients in regard to managed care organizations + Conducts utilization review for managed care cases in… more
