- UPMC (Pittsburgh, PA)
- The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... Health Plan members. This fully remote role will be responsible for assuring physician commitment and delivery of comprehensive high quality health care to UPMC… more
- Ochsner Health (New Orleans, LA)
- …Come make a difference at Ochsner Health and discover your future today!** The Physician Advisor (PA- Utilization Management) serves as the physician leader ... and comply with Federal and State regulations/quality initiatives. Reports to the System Medical Director of Utilization . This job description is a summary of… more
- Sutter Health (Sacramento, CA)
- …expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical necessity, documentation best practices, level ... Health Internal Physician Advisor Services (IPAS). The physician Advisor will work closely with the medical... physician Advisor will work closely with the medical staff, including house staff, and all utilization… 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 clinical ... and Hackensack UMC. These include but are not limited to utilization review, hospital reimbursement, clinical compliance, case management, and transitions of… more
- Intermountain Health (Las Vegas, NV)
- … management, care management, claims, network management, and finance. As the Medical Director for Utilization Management, you are responsible, in partnership ... with MG Clinical Leadership, for the appropriate utilization of medical services within established guidelines...(QMMC) and other designated committees defined by the organization. Physician will be engaged in these important projects along… more
- Tenet Healthcare (Detroit, MI)
- …and safe and timely patient throughput. Will integrate national standards for utilization management supporting medical necessity and denials prevention. ... Utilization Management Monitors the review process to ensure medical necessity patients to be in the appropriate status...medical staff on actionable items Implements and monitors physician “peer to peer” review process with payers to… more
- The County of Los Angeles (Los Angeles, CA)
- … direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one ... hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty...utilization review standard. Under the direction of a physician member of the Utilization Review Committee,… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- … Utilization Review Nurse combines clinical expertise with knowledge of medical appropriateness criteria, and applies principles of utilization and quality ... of level of care. + Refers cases failing inpatient medical necessity screening to physician advisor for...+ Communicates following the chain of command regarding proper utilization of resources, physician concerns, length of… more
- Beth Israel Lahey Health (Burlington, MA)
- …making a difference in people's lives.** In conjunction with the admitting/attending physician , the Utilization Review RN assists in determining the appropriate ... level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria… more
- Catholic Health Services (Melville, NY)
- …as a liaison between patient account services, physicians, care coordinators, Utilization and Appeals Managers, physician advisors and facility departments. ... a home health service, hospice and a network of physician practices across the island. At Catholic Health, our...Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help… more
- Excellus BlueCross BlueShield (Utica, NY)
- …Description: This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services ... policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director. + Utilizes appropriate communication techniques… more
- Emory Healthcare/Emory University (Duluth, GA)
- …The Utilization Review (UR) Specialist is responsible for conducting medical necessity reviews by utilizing Milliman and Interqual Guidelines in conjunction with ... patient chart, clinical judgement, and discussions with the attending physician and/or physician advisor. + The UR...physician advisor. + The UR Specialist will perform utilization review by completing a timely and comprehensive review… more
- Trinity Health (Des Moines, IA)
- …for the patient/family for clarification of the change. + Documents in the Medical Record Utilization Management forms accurately to reflect the appropriate ... a place to go when you're in need of medical attention. Our Mission is based on improving the...the MercyOne Family! We are looking to hire a Utilization Review RN! Responsible for the review of inpatient… more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management ... consultation to the leadership and staff who perform the functions of Utilization Management (UM), Case Management (CM), Transition Planning/ Discharge Planning, and… more
- Alameda Health System (Oakland, CA)
- …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating in ... System Utilization Management SUM Utilization Review RN...high- standards of patient care. This role involves evaluating medical necessity, assessing treatment plans, and collaborating with healthcare… more
- Hackensack Meridian Health (North Bergen, NJ)
- …insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + Obtains and evaluates ... healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management** is a member of the healthcare team and is responsible for… more
- Intermountain Health (Murray, UT)
- …responsible for the development, implementation, evaluation, and operational management of utilization review programs to include prior authorization, acute and post ... service lines of business(s). The position requires an understanding of utilization management industry benchmarks, best practices and regulatory environment for the… more
- Catholic Health Services (Melville, NY)
- …queries from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, ... hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the… 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 Position Type: Full ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves medically… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours a week. + **Hospital:** Ascension Saint Thomas + **Location:** Remote ... located with in the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal role, you'll lead clinical… more