- UCLA Health (Los Angeles, CA)
- …for accuracy, confirming the receipt of necessary documentation to support the denial and ensuring compliance with all contractual obligations and state and federal ... laws/regulations. You will extrapolate and summarize essential information for the UM Manager and Medical Director and regularly meet with them for clinical guidance in resolving cases. You will also document appeals in the tracking system and maintain… more
- Hackensack Meridian Health (Hackensack, NJ)
- …healthcare and serve as a leader of positive change. The Case Management Care Coordinator , Utilization Management is a member of the healthcare team and ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Neptune, NJ)
- …and serve as a leader of positive change. The **Care Management , Care Coordinator , Utilization Management ** is a member of the healthcare team and ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Perth Amboy, NJ)
- …healthcare and serve as a leader of positive change. The Care Management , Care Coordinator , Utilization Management is a member of the healthcare team and ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Edison, NJ)
- **Overview** The Care Management , Care Coordinator , Utilization Management is a member of the healthcare team and is responsible for coordinating, ... of the patient?s treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Manahawkin, NJ)
- …and post-acute services. **Responsibilities** A day in the life of a Care Coordinator , Utilization Management at Hackensack Meridian Health includes: + ... serve as a leader of positive change. The Care Coordinator , Care Management is a member of...skills + Familiar with hospital resources, community resources, and utilization management **Licenses and Certifications Required:** +… more
- UCLA Health (Los Angeles, CA)
- …Under the direction and supervision of the RN Assistant Director, the Case Management Coordinator is responsible for patient high risk care coordination ... the next level of reviewer in review, and health plan contracts. The Case Management Coordinator will also be responsible for: + Preparation and maintenance of… more
- Universal Health Services (Chicago, IL)
- …continued treatment based on payer's criteria and in accordance with the hospital wide Utilization Management Plan. Serves as liaison to 3rd and 4th party ... physician reviews with payers as required. Maintains all records/data pertaining to the Utilization Management Program. Actively participates in Utilization … more
- Geisinger (Danville, PA)
- …and/or penalties. Job Duties + Serves as primary auditor of all written denial notifications prior to mailing to assure compliance with all regulatory time frames ... with decision making and documentation processes. + Works with staff and management team to support recommendations for high risk members to improve transitions… more
- Universal Health Services (Chicago, IL)
- …Responsible for all denial and appeal activities for the Utilization Management department, including Expedited Appeals, Standard Appeals, External ... to resolve issues related to appeals. Maintains all records/data pertaining to the Utilization Management Program. Actively participates in Utilization … more
- Baptist Memorial (Memphis, TN)
- …using evidence based criteria. Areas of work include payer notification, authorization management , denial management , escalations, and communication and ... Summary The Authorization Coordinator is responsible for facilitating information documentation and transmission vital to the effectiveness of utilization review… more
- Trinity Health (Livonia, MI)
- …FUNCTIONS AND RESPONSIBILITIES MAY INCLUDE 1. Provides leadership and expertise for utilization management processes. 2. Manages the DNFB list and other ... health-related field, nursing preferred. Experience: Three years recent acute care utilization management experience. Licensure/Certification: Current RHIT or RN… more
- Rush University Medical Center (Chicago, IL)
- …managers, community providers, payers and internal/external agencies to provide case management support services related to effective utilization of services ... 1** **Work Schedule:** 8 Hr **Summary:** The Clinical resource coordinator (CRC) applies a collaborative approach in working with...denial appeals, and / or level of care management processes. * In accordance with the case … more
- Hartford HealthCare (Southington, CT)
- …of Connecticut's most comprehensive healthcare network as a Quality Improvement Coordinator . Hartford HealthCare at Home, the largest provider of homecare services ... corrected billing and chart reviews. **Document patient accounting system with all denial activity and actions taken. **Compile monthly denial reports.… more
- Baystate Health (Springfield, MA)
- …pediatric specialties. Prevents denials by identifying and documenting payor requirements for utilization management by employing a variety of methods including ... **Summary:** The Referral Authorization Coordinator is responsible for providing a variety of...payment for services provided. **4)** Consistently monitors and works denial and no referral reports to obtain prior authorizations… more
- Houston Methodist (Houston, TX)
- …complex patients, receiving coaching from experienced Transplant Coordinators and management , benefiting from their practice. The Pre-Transplant Coordinator ... At Houston Methodist, the Pre-Transplant Coordinator position a registered nurse, responsible for participating in department initiatives, facilitating, and… more
- Highmark Health (Harrisburg, PA)
- …and third party payers. + Maintains a working knowledge of care management , care coordination changes, utilization review changes, authorization changes, ... coordination of care in accordance with recognized standards of practice for Care Management . The incumbent utilizes expertise in care management to promote a… more
- University of Virginia (Charlottesville, VA)
- …efficiently. Takes ownership for resolving scheduling conflicts and communicates with management team and care providers to resolve scheduling issues. g. Requests ... providers or other health care professionals in the pre-authorization or denial process. 4. Educates patients, parents, guardians and/or appropriate designee on… more
- Penn Medicine (Philadelphia, PA)
- … and appeals correspondence. + Maintains database for the department and the utilization management requirements for the hospital information system and within ... communication. + Supports the activities of the Clinical Appeals Coordinator in all phases of the Clinical Quality and... in all phases of the Clinical Quality and Utilization Management functions including but not limited… more
- The County of Los Angeles (Los Angeles, CA)
- …methods include group, family, individual and conjoint therapy, clinical case management , and crisis intervention. Positions allocable to this class also provide ... problem, which may include individual, group, family or marital counseling, case management , and/or referral to another treatment source such as a psychiatrist, a… more