- CoxHealth (Lake Spring, MO)
- …Job Summary ◦ This position is responsible for facilitating timely and accurate physician documentation in the medical record through concurrent chart review . ... team regarding proper clinical documentation utilizing approved guidelines. Understand and utilization of ICD-10-CM and PCS coding assignment and follow Official… more
- Prisma Health (Maryville, TN)
- …of care and timely implementation of plan of care in accordance with hospital(s) Utilization Review Plan and CMS regulation. Maintains expert level knowledge of ... timely contacts with insurers to provide clinical information to support physician referrals. In collaboration with physicians, leads the multidisciplinary team… more
- Hackensack Meridian Health (Hackensack, NJ)
- The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical ... Hackensack University Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Hackensack Meridian Health (Hackensack, NJ)
- **The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- CommonSpirit Health (Phoenix, AZ)
- …by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. + Physician Advisor Sub-specialty Certification ... This role will be an expert on matters regarding physician practice patterns, over and under- utilization of...by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. **Required… more
- AdventHealth (Orlando, FL)
- …for our contracted managed care payers. The PA role is responsible for providing physician review of utilization , claims management, and quality assurance ... Collaborates with Senior Medical Officers with contracted managed care payers regarding utilization review management activities and maintain a positive and… more
- Atlantic Health System (Summit, NJ)
- …from ABQAURP (The American Board of Quality Assurance and Utilization Review Physicians), AAPL (American Association for Physician Leadership's Physician ... in Management course), or CPUR (Certification Program in Utilization Review ), Institute for Healthcare Improvement courses, or physician advisor training… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE ... see comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're… more
- The County of Los Angeles (Los Angeles, CA)
- …Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician member of the ... UTILIZATION REVIEW NURSE SUPERVISOR II Print...by subordinate supervisors on number and status of reviews, physician advisor referrals, and type of physician … more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... this position is able to cover a multitude of utilization review functions through point of entry,...process improvements). **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates with the physician and all members of the interprofessional health care… more
- Emory Healthcare/Emory University (Decatur, GA)
- …_,_ and leadership programs + And more **Description** We're seeking a **Clinical Utilization Review Nurse Preceptor (Registered Nurse / RN)** . This individual ... be responsible for training, mentoring, and coaching for the Utilization Review Department and must be an...+ Will play a vital role in partnering with Physician Advisors to ensure the Physician role… 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 ... this position: *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Utilization Review Assistant is responsible for taking the data provided to their ... department and using it to communicate necessary information to both the Utilization Review Nurses and insurance companies. Making sure that all necessary… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... of InterQual Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of CMS Regulations. **Working… more
- CaroMont Health (Gastonia, NC)
- …RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal ... practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case Management preferred. Minimum… more
- Beth Israel Lahey Health (Plymouth, MA)
- …and identifies trends/root causes of denials for discussion with the internal team, physician advisor and the Utilization Review Committee as appropriate. ... you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We Are:** At… more
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Part- time and will work 8-hour, Day ... US hospitals are four times designated. Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and … more
- Providence (Olympia, WA)
- **Description** The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management ... + Bachelor's Degree Or Associate's Degree in Nursing + 3 years of Utilization Review , Care Management, Quality Management, and/or Discharge planning **Why Join… more
- Dignity Health (Rancho Cordova, CA)
- …position is work from home** **within driving distance of Sacramento, CA** **.** As a Utilization Review (UR) LVN, you will use clinical judgement in providing ... utilization management (UM) services. The focus is to provide...assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review . Responsibilities may… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
