- AdventHealth (Tampa, FL)
- …such as heart failure, cancer and other diseases. **The role youll contribute:** The Utilization Management (UM) Specialist works under the direction of the ... also located at AdventHealth Tampa, leads the way in clinical and academic research in the areas of neuroscience,... Utilization Management Manager and supports the Utilization … 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 ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...Experience Required: At least 5 years of varied RN clinical experience in an acute hospital setting. At least… more
- Henry Ford Health System (Troy, MI)
- …quality of care provided by the primary care team. He/she works with utilization management reports, corporate data stores, and information services to optimize ... waste, and rework in the region, and improve drug utilization . The Pharmacy Specialist will be instrumental...Pharmacy degree or equivalent experience with evidence of advanced clinical training and knowledge in patient care and applied… more
- BriteLife Recovery (Englewood, NJ)
- …compliance. + Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in denials, approvals, ... What you will be doing? The Utilization Review (UR) Specialist is a...and advocating for appropriate levels of care. The UR Specialist works closely with clinical staff, admissions,… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
- Baylor Scott & White Health (Dallas, TX)
- …management to provide services to members. + Keep updated on approved utilization management criteria, guidelines, and regulations. **Key Success Factors** + ... use treatment experience and/or behavioral health treatment + Experience with Utilization Management for Substance use treatment experience and/or behavioral… more
- Spectrum Billing Solutions (Skokie, IL)
- …cycle management company for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team. The Utilization Review ... will utilize his or her knowledge and skills to review clinical information and obtain initial and continuing authorizations for behavioral healthcare services.… more
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Utilization Review Specialist (Remote Option in Wisconsin) **Cost Center:** 101651289 ... **_Remote work available for Wisconsin residents only_** **JOB SUMMARY** The Utilization Review Specialist , Revenue Cycle Provide quality assurance of… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of ... urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization,… more
- Reno Behavioral Healthcare Hospital (Reno, NV)
- …an interdisciplinary approach to support continuity of care. + Provides utilization management , transfer coordnation, discharge planning, and issuance of ... The UR Specialist reviews and monitors patients' utilization ...and quality of care. + Responsible for the proactive management of patients with the objective of improving quality… more
- Hackensack Meridian Health (Hackensack, NJ)
- …include but are not limited to utilization review, hospital reimbursement, clinical compliance, case management , and transitions of care, as outlined in ... The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of … more
- Nuvance Health (Danbury, CT)
- … outcomes while managing the cost of care and providing timely and accurate clinical information to payors. Utilization management provides clinically based ... one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the...discuss case with the attending MD to gather additional clinical information and request additional documentation to support inpatient… more
- Commonwealth Care Alliance (Boston, MA)
- …operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized clinical review and authorization ... Manager, Utilization Management reports to the Director of Utilization Management * Oversees clinical decision review for services requiring prior… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services ... and collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- Tufts Medicine (Melrose, MA)
- …for patients on anticoagulants located at 15 Green St. in Melrose, MA. The Clinical Pharmacy Specialist - Anticoagulation Management Service will focus on the ... education, and perioperative management . In addition, the clinical pharmacy specialist will be involved in...a related area of practice. 6. Experience in drug utilization review and analysis. **Duties and Responsibilities** **:** The… more
- UPMC (Pittsburgh, PA)
- …coordinate care for our members. Provide innovative and applicable ideas in clinical program development, utilization management , formulary management ... Plan is hiring a full-time Clinical Pharmacy Specialist to support the Care Management team...confidentiality. + Provide innovative ideas for new and existing clinical program development, utilization management ,… more
- HCA Healthcare (Dallas, TX)
- …with both hospital Case Management and the Rehab Medical Director. The Clinical Rehabilitation Specialist works closely with hospital case management to ... **Description** **Medical City Healthcare** ** Clinical Rehabilitation Specialist ** **Full Time Weekends**... liaison coordinating admissions for inpatient rehabilitation preferred + Clinical experience in the care and management … more
- HCA Healthcare (Richmond, VA)
- **Description** **Introduction** Do you have the PRN career opportunities as a Clinical Rehab Specialist PRN you want with your current employer? We have an ... of colleagues. Do you want to work as a Clinical Rehab Specialist PRN where your passion...screenings and assessments in collaboration with both hospital Case Management and the Rehab Medical Director and works closely… more
- HCA Healthcare (Dallas, TX)
- …includes monitoring patient medication regimens and providing appropriate interventions. The Clinical Specialist shall also assist in mentoring pharmacy staff ... **Description** ** Clinical Pharmacist Specialist BMT** **BMT Experience...defined by Pharmacy Leadership. Develop, manage and mentor antimicrobial management program (AMP). + Documents all clinical … more
- Organon & Co. (Plymouth Meeting, PA)
- **Job Description** **The Position** The Women's Health Clinical Account Specialist (WH CAS) supports customers by providing clinical information on our ... needs, to help the provider or system meet the goals of their patients. The Clinical Account Specialist is a key member of our customer-facing team and is… more
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