- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Utilization Review / Quality Assurance Coordinator is responsible for all compliance related paperwork and ensures all compliance ... paperwork is completed in a timely manor for the Upstate/Syracuse City School District school-based mental health care program. This position helps ensure successful visits by DNV and OMH when they occur. Monitors and maintains performance improvement… more
- UPMC (Pittsburgh, PA)
- …managed care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance . + Promote adherence to URAC ... The Regional Medical Director, CC/DP and Utilization Review , provides clinical and management...quality and cost-effectiveness of patient care. + Analyze utilization data to identify trends and implement strategies to… more
- State of Connecticut, Department of Administrative Services (New Haven, CT)
- …and medical care delivery and reimbursement systems; + Participates in utilization review and/or quality assurance programs; + Conducts various types of ... Utilization Review Nurse (40 Hour) Office/On-Site...quality and appropriate medical management, cost containment, peer review and rehabilitation; + Summarizes and analyzes data; +… more
- WMCHealth (Valhalla, NY)
- …hospital or health care agency, one of which must have been in the area of utilization review , quality assurance , risk management or discharge planning. ... the implementation or investigation of the procedures specified in the Quality Management, Utilization Review and Discharge Planning Program at Westchester… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity ... using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity… more
- BAYADA Home Health Care (Orlando, FL)
- …should be available Monday-Friday from 8:30am-5:00pm. _Medicare, Coder, OASIS Review , Utilization Review , Quality Assurance , Remote, Home Health ... Home Health Care is hiring a full time OASIS Review and Coding Manager. The OASIS and Coding ...monitoring Outcome and Assessment Information Set (OASIS) documentation for quality and adherence to policies and procedures. As a… more
- BAYADA Home Health Care (Austin, TX)
- …with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance , Remote, Home Health Coding, ... Home Health Care has an immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work remotely. RN, PT, OT, and… more
- Beth Israel Lahey Health (Burlington, MA)
- …coordinates utilization review , discharge planning and monitors quality assurance for Lahey Clinic inpatient admissions. Leads the multidisciplinary ... in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient...needed. 10) Supports all service line activities related to utilization and quality management. 11) Assists in… more
- Centene Corporation (Nashville, TN)
- … quality improvement activities. + Perform medical review activities pertaining to utilization review , quality assurance , and medical review ... to providers that would improve utilization and health care quality . + Review claims involving complex, controversial, or unusual or new services in order… more
- Centene Corporation (Atlanta, GA)
- … quality improvement activities. + Performs medical review activities pertaining to utilization review , quality assurance , and medical review ... + Provides medical expertise in the operation of approved quality improvement and utilization management programs in...with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends… more
- Centene Corporation (Charlotte, NC)
- … quality improvement activities. Performs medical review activities pertaining to utilization review , quality assurance , and medical review ... service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with… more
- Stanford Health Care (Palo Alto, CA)
- …management, including the principles and practices of discharge planning, utilization review , and quality assurance /improvement + Knowledge of the ... responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient… more
- MTC (Bryan, TX)
- …co-dependency, and related disorders. 2. Performs complex technical assistance work; implements quality assurance utilization review procedures; and ... and procedures. 3. Assists in monitoring, reviewing, interpreting, and evaluating quality of services; assists in compiling and analyzing data and preparing… more
- University of Maryland, Baltimore (Baltimore, MD)
- …Directs activities related to the delivery of medical care and clinical services such utilization review , quality assurance , policies, procedures and ... operational, and leadership skills and experience in neonatal care, quality , and safety to lead the clinical service. The...clinical and reimbursement activity. 7. Participates in the Peer Review Program as described in the Medical Staff Bylaws… more
- CenterLight Health System (Ridgewood, NY)
- …(5+) years of experience in care/case management, disease management, population health management, utilization review , quality assurance , or discharge ... model. + Escalates questions or concerns during the assessment to the quality review team to ensure appropriate completion of UAS-NY and handling of on-site… more
- FlexStaff (New York, NY)
- …(5+) years of experience in care/case management, disease management, population health management, utilization review , quality assurance , or discharge ... delivery model. Escalates questions or concerns during the assessment to the quality review team to ensure appropriate completion of UAS-NY and handling of… more
- Sevita (Indianapolis, IN)
- …crisis intervention emergency procedures; participate in emergency coverage system; and oversee Utilization Review , Quality Assurance , investigations, ... oversee the services provided to children and their families, and ensure the quality of the services provided. + Oversee services at all four locations within… more
- Sevita (Terre Haute, IN)
- …crisis intervention emergency procedures; participate in emergency coverage system; and oversee Utilization Review , Quality Assurance , investigations, ... families, including development and implementation of service plans, and ensure the quality of the services provided. + Oversee treatment services including, but not… more
- Sevita (Lowell, MA)
- …coverage system. + May develop and implement crisis intervention emergency procedures, oversee Utilization Review , Quality Assurance , investigations, and ... oversee counselors, psychological services, and service plans to ensure quality psychological evaluations and services for company program participants; proactively… more
- HCA Healthcare (Nashville, TN)
- …center regarding the therapy services offered by Reliant Rehabilitation. + Participate in utilization review , quality assurance , resident care ... to include management and coordination of clinical activities, fiscal management, and quality patient care. The Director shall assume overall responsibility for the… more