- Crouse Hospital (Syracuse, NY)
- … staff and/or other health care professionals in accordance with the hospitals Utilization Review guidelines to ensure efficient utilization of health ... Conducts clinical review on cases referred by case management...to practice medicine. Preferred: Additional education in quality and utilization management through continuing medical education programs… more
- MetroHealth (Cleveland, OH)
- …is consistent with contractual agreements. Serves as a clinical resource to the physician group and Utilization Management Specialists. Upholds the mission, ... - Care Coordination, plans, coordinates, and evaluates all activities impacting utilization review (eg, the centralized referral/authorization area specifically… more
- CommonSpirit Health (Houston, TX)
- …Candidates licensed in other states will be considered for future openings.** As the Utilization Management Physician Advisor II, the Physician Advisor ... staff ensuring that the system is optimized for effective physician use. The PA helps facilitate training for the...Steering Committee + Extended Length of Stay Rounds + Utilization Review Committee + Care Management… more
- Highland Hospital (Rochester, NY)
- …Physician **Department/Cost Center:** 776 - Quality Assurance **Job Description:** The Utilization Management Physician Advisor is responsible for ... serving the hospital through teaching, consulting, and advising the utilization management department. The Physician ...RN will refer cases to the UM PA for review of inpatient, observation or alternative level of care… more
- CommonSpirit Health (Rancho Cordova, CA)
- …of four 10-hour shifts per week, or five 8-hour shifts per week.** As the Utilization Management Physician Advisor (PA), the PA conducts clinical case ... of health care services. The PA communicates remotely with case and utilization management to discuss selected cases and make recommendations regarding level… more
- CommonSpirit Health (Phoenix, AZ)
- …and out in the community. **Responsibilities** This is a remote position. As the Utilization Management Physician Advisor (PA), the PA conducts clinical case ... of health care services. The PA communicates remotely with case and utilization management to discuss selected cases and make recommendations regarding level… more
- Beth Israel Lahey Health (Burlington, MA)
- …resource allocation - Serves as physician expert and provide support to utilization review team regarding utilization decisions pertaining to commercial ... necessity recommendations, as requested Policy Setting Responsibilities Responsible for utilization review and medical necessity recommendations, as requested… more
- Guthrie (Sayre, PA)
- Position Summary: The Utilization Management (UM) Reviewer , in collaboration with other internal and external offices, payors, and providers and staff, is ... responsible for the coordinates Utilization Management (UM) processes and requirements for...prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures authorization as appropriate… more
- Prime Therapeutics (Columbus, OH)
- …- Oncology - REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do ... needed or required. **Job Description** + Directs daily involvement in the following utilization management functions: + Reviews all cases in which clinical… more
- Evolent Health (Columbus, OH)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer , Interventional Pain Management , you will be a key ... Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent Health (Columbus, OH)
- …As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Kepro (Lombard, IL)
- …solutions in the public sector. Acentra seeks an Internal Medicine or Family Practice Physician Reviewer (Illinois Remote, PRN) to join our growing team. Job ... Summary: The Internal Medicine or Family Practice Physician Reviewer will provide principal leadership and...and clinical expertise to operations relating to the peer review process, utilization review activities,… more
- Trinity Health (South Bend, IN)
- …authorizations, referrals) and will contact the physician /office and Case Management / Utilization Review colleagues as necessary. Ensures all ... entered on the wrong encounter. Validates complete and accurate documentation by Physician / Utilization Management colleague is met prior to completing… more
- Kepro (Los Angeles, CA)
- …ensures the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process with the California Mental Health Services Authority (CalMHSA). ... candidate must reside and work in California. ** Job Responsibilities + Review and interpret patient records against established criteria to determine medical… more
- Kepro (Richmond, VA)
- …care, preferably with experience in Utilization Management and/or Quality Management + Ability to review cases to determine the appropriate level of ... ASAM criteria. + Knowledge of current National Committee for Quality Assurance (NCQA)/ Utilization Review Accreditation Committee (URAC) standards. Why us? We are… more
- Elevance Health (Memphis, TN)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... **Nurse Reviewer I** **Location:** Within 50 miles of a...required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-10 + Previous … more
- Ellis Medicine (Schenectady, NY)
- …include Director of Quality and Risk, Director of Family Medicine Residency Program, Physician Advisor Utilization Management , and System Wide Chiefs. The ... accordance with Hospital Policy and Procedure, and oversight of physician contract management functions. + Serves as...the budgets of the Clinical Departments. + Provides contractual review for and reviews performance of all physicians who… more
- AdventHealth (Maitland, FL)
- …managed care payers. The Medical Director is responsible for providing physician review of utilization , claims management , and quality assurance related ... need.Collaborates with Senior Medical Officers with contracted managed care payers regarding utilization review management activities and maintain a positive… more
- WMCHealth (Valhalla, NY)
- …role in ensuring physician support and execution of for Utilization Management and Documentation strategies and processes. Responsibilities: + Reviews ... Integrated Case Management including mentoring/coaching care coordinators, utilization review staff and social workers. +...Physician Advisor or having 3-5 years as a Physician Reviewer /Advisor with a third party leveling… 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 ... and HackensackUMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management , and transitions of… more