- Beth Israel Lahey Health (Plymouth, MA)
- …you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding UR… more
- Beth Israel Lahey Health (Plymouth, MA)
- …is expanding its **Care Transitions Department** and seeking an experienced ** Manager of Utilization Review & Denials Management** and ** Utilization ... or other case management certification preferred or in progress ** Manager - Utilization Review & Denials Management** This role is ideal for a Manager… more
- Nuvance Health (Danbury, CT)
- …the direct oversight of daily operations of clinical denial prevention and Utilization Review (UR) activities, including daily collaboration with physicians as ... departments, team members, providers, delegates, and community partners. In addition, the Manager Denials Prevention & Appeals Operations is responsible for… more
- Hartford HealthCare (Farmington, CT)
- …practices. *_Position Responsibilities:_* *Key Areas of Responsibility* *Denial Resolution* . Review DRG validation denials from payers, analyze the denial ... The Denial Specialist 2 is responsible for reviewing, analyzing, and appealing denials related to DRG (Diagnostic Related Group) validation denials . This… more
- Catholic Health (Buffalo, NY)
- …(the payers) and internal stakeholders including, but not limited to, Utilization Review , Case Management, Clinical Documentation Integrity, Health Information ... any other certification approved by management + Certification in a Nationally Recognized Utilization Review Criteria set is preferred EXPERIENCE + Minimum of… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.This is a full-time role and will be required to work ... ) required or completed within three years of hire **Title:** * Utilization Review Manager * **Location:** *MN-Minneapolis-Downtown Campus* **Requisition… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- AdventHealth (Altamonte Springs, FL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... and financial indicators including LOS, cost per case, avoidable days, resource utilization , readmission rates, concurrent denials , and appeals. * Uses data… more
- Dayton Children's Hospital (Dayton, OH)
- … TeamSchedule:Full timeHours:40Job Details:Under the supervision of the Manager of Utilization Management, the Utilization Review RN conducts medical ... a resource to the physicians, collaborates with the Care Manager in the development and implementation of the plan...denials . The Physician Advisor role will support the Utilization Review RN for second level clinical… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 250924-5613FP-001 Location East Hartford, CT Date Opened 9/30/2025 12:00:00 AM Salary ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=)… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Prime Healthcare (Ontario, CA)
- … working for a Health Plan. + At least 3 years of experience in utilization review , referrals, authorizations, denials and appeals. + Current BCLS (AHA) ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/222731/ utilization - review -rn/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306)… more
- Beth Israel Lahey Health (Plymouth, MA)
- …care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care ... the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established… more
- Mount Sinai Health System (New York, NY)
- …department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status of Medical ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by… more
- Catholic Health Services (Melville, NY)
- …services and coordinates utilization /appeals management review . + Assist Utilization and Appeals Manager in setting up communications with payors and/ ... utilization data in a timely fashion. + Monitors denials as well as all financial metrics associated with...and facility departments. + Develops/validates daily work lists for Utilization and Appeals Manager . + Assist with… more
- Beth Israel Lahey Health (Plymouth, MA)
- …care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care ... the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established… more
- Amergis (French Camp, CA)
- …Case Management experience ? Key Responsibilities: + Discharge Planning + Appeals & Denials + Utilization Review + InterQual assessments + Collaborating ... Salary: $3242 / Week The RN Case Manager is responsible for coordinating continuum of care...experience + Denials & Appeals experience + Utilization Review experience + InterQual experience +… more
- Houston Methodist (Katy, TX)
- …Audit, Business Practices, Health Information Management, Patient Access Services, and Utilization Review as needed to ensure operational billing compliance ... At Houston Methodist, the Manager Revenue Cycle position is responsible for the...to: medical coding, insurance billing, collections, patient account resolution, appeals/ denials , customer service, cash applications, revenue integrity, etc. This… more
- Bassett Healthcare (Cooperstown, NY)
- …continuous improvement in both areas. + Refers cases and issues to Case Review , Utilization Committee, Medical Director, and Director of Quality in compliance ... issues as needed + Interfaces with IPRO and other review agencies regarding denials , retrospective reviews. +...resources and financial indicators including LOS, excess days, resource utilization , denials and appeals, swing bed statistics.… more
- Sharp HealthCare (San Diego, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... medical record and provides information to the department head as indicated. + Utilization review and utilization managementThe RN CM I will:Conduct… more