- Kelsey-Seybold Clinic (Pearland, TX)
- **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to ... authorization prior to services being rendered for members. The Utilization Review Specialist (LVN) serves...plan, ACO, IPA, or provider group or 3 years clinical nursing experience Preferred: N/A **License(s)** Required: TX LVN… more
- BayCare Health System (Cotton Plant, AR)
- …Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review Specialist Senior **Location** Clearwater:Morton Plant | Clinical | Part ... and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing team. The UR ... will utilize his or her knowledge and skills to review clinical information and obtain initial and... information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and… more
- HonorHealth (Scottsdale, AZ)
- …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization,… more
- Universal Health Services (Groton, CT)
- …Washington, DC, Puerto Rico and the United Kingdom. www.uhs.com Job Summary: The Utilization Review Specialist is responsible for the pre-certification, ... (UHS), has an immediate opening for a full-time UR Specialist . Stonington Institute is committed to providing quality substance...or related Human Service Field or RN. Knowledge of Utilization Review Processes, insurance plans, mental health… more
- Reno Behavioral Healthcare Hospital (Reno, NV)
- The UR Specialist reviews and monitors patients' utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties ... include providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency...times. + Addresses care issues with the Director of Clinical Services and Chief Medical Officer/Medical Director as appropriate.… more
- WestCare Foundation (Henderson, NV)
- Utilization Review Specialist Job Details Job Location Henderson - 1711 Whitney Mesa - Henderson, NV Position Type Full Time Education Level 2 Year Degree ... LPN or RN and/or Bachelors or Masters level CADC/LADC with 2 years utilization review experience, preferred experience working with individuals with psychiatric… more
- Insight Global (Boston, MA)
- …facilities under the provisions of benefits plan. The LTSS Service Authorization Specialist is responsible for applying clinical and benefit administration ... Job Description Clinical Effectiveness (Authorization) Unit is primarily responsible for...Term Services and Supports (LTSS). The LTSS Service Authorization Specialist provides accurate, prompt, and appropriate medical authorizations to… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and approve… more
- Truman Medical Centers (Kansas City, MO)
- …into myWORKDAY (http://www.myworkday.com/trumed/d/home.htmld) to search for positions and apply.** Utilization Specialist 101 Truman Medical Center **Job ... training, coaching and consulting to outside organizations. **Job Description** The Utilization Specialist will verify all financial and insurance information,… 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 ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and approve… more
- Universal Health Services (Auburn Hills, MI)
- Responsibilities Utilization Management - Precertification Specialist HAVENWYCK HOSPITAL (a UHS facility) Havenwyck Hospital sa Joint Commission-accredited and ... information, please visit us at www.havenwyckhospital.com POSITION SUMMARY: The Utilization Management Precertification Specialist has responsibility for… more
- Sanford Health (Sioux Falls, SD)
- …level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to assure ... relating to determination of medical necessity, authorization, continued stay review including diagnosis and procedural coding for working diagnosis related… more
- University of Virginia (Charlottesville, VA)
- As a Medication Utilization , Formulary, and Policy Specialist , you will play a crucial role in optimizing medication management practices UVA. The primary focus ... position is to manage the completion of formulary activities, support medication utilization projects, and ensure timely policy management within the department of… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** The Senior Utilization Review Physician Specialist collaborates with the healthcare team in the management and resolution of activities that ... population and HackensackUMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Alameda Health System (San Leandro, CA)
- … utilization and an appropriate level of care. 5. Coordinates all utilization review functions, including response to payor requests for concurrent and ... continued stay using evidence from the medical record and clinical review tools, as well as input...of Case Management experience in an acute setting or utilization review at a medical group or… more
- LA Care Health Plan (Los Angeles, CA)
- Enhanced Care Management Clinical Specialist II Job Category: Clinical Department: Care Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... required to achieve that purpose. Job Summary The Enhanced Care Management (ECM) Clinical Specialist II is responsible for the management and oversight… more
- Trinity Health (Farmington Hills, MI)
- …rejection, denial and appeal activities with Regional Health Ministries (RHM) based Utilization Review /Case Management departments; + Reviews and understands ... utilization review and coverage guidelines for multiple payers; + Identifies...and reviews findings with all levels of Payment Resolution Specialist for further review . Serve as a… more
- SSM Health (St. Louis, MO)
- …Cardinal Glennon Children's Hospital **Worker Type:** Regular **Job Highlights:** Full-time clinical pharmacist position dedicated to providing clinical and ... promoting rational, safe, and cost-effective drug therapy by developing and providing clinical services in their area of expertise. Conducts drug therapy monitoring,… more
- Trinity Health (Farmington Hills, MI)
- …rejection, denial and appeal activities with Ministry Organization (MO) based Utilization Review /Case Management departments; + Reviews and understands ... utilization review and coverage guidelines for multiple payers; + Identifies...and reviews findings with all levels of Payment Resolution Specialist for further review . Serve as a… more