- Sprenger Wellspring Silver Maple (Lorain, OH)
- …professional nurse in conjunction with other members of the health care team ( physician , therapists, nurses, medical social worker, and home health aide) based ... on medical and nursing diagnoses, identified patient care needs and...Intervention Performs skilled nursing procedures as ordered by patients physician in accordance with Home Health policies and procedures… more
- Aveanna Healthcare (Birmingham, AL)
- …the plan of care and patient needs. Participates in quality improvement, utilization review , and infection control activities as requested. Attends appropriate ... as established by the plan of care, the interdisciplinary team, attending physician and Hospice Medical Director. Territory is primarily Jefferson County,… more
- GIBSON AREA HOSPITAL (Gibson City, IL)
- …Treatment Plan. 24. Participates in the completion of maintenance of patients medical records, including the record of the physician orders. 25. ... or individualizes a predefined, goal consistent and continuous manner by utilization of and adherence to pre-determined standards which define the structure,… more
- US Fish and Wildlife Service (Titusville, FL)
- …authorized government physician . You will also be required to periodic medical examinations throughout employment. The Work Capacity Test (WCT-Pack Test) as a ... and instruct lower graded employees on crewmember duties; 2) plan action and direct utilization of fireline resources on less complex fires; and 3) for more complex… more
- WORKCARE INC (Albany, OR)
- …in line with the scope of practice and as supported by the CMD or Medical Review Officer (MRO). Assists the CMD with health care administration work, such ... clinical diagnosis, therapeutic intervention, and rehabilitation of injuries and medical conditions. Industrial Injury Prevention Specialists work under the… more
- GIBSON AREA HOSPITAL (Gibson City, IL)
- …and patient education or assist with diagnostics, such as specialized tests per physician orders. GIBSON AREA HOSPITAL & HEALTH SERVICES MISSION STATEMENT To provide ... treat and educate patients in a clinic setting, keeping records of medical histories and performing diagnostics. They work with patients with postoperative… 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 ... records for the patient population and Hackensack University Medical Center. These include but are not limited to... Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case… more
- Commonwealth Care Alliance (Boston, MA)
- … Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for providing leadership and ... medical reviews, appeals as appropriate, correspondence regarding review determinations and physician peer review...Serve as the lead for CCA's Utilization Review functions working closely with other medical … more
- The County of Los Angeles (Los Angeles, CA)
- …recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the committee of new or ... Medi-Cal reimbursement. + Analyzes cases for referral to the physician advisor to ensure that the admission or continued...I:One year of experience performing the duties of a Utilization Review Nurse* or Medical … more
- The County of Los Angeles (Los Angeles, CA)
- …administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the ... Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician...for and the effective conduct of the system to review patients' medical charts to ascertain the… more
- Beth Israel Lahey Health (Boston, MA)
- …a difference in people's lives.** Position Summary: In conjunction with the admitting/attending physician , the Utilization Review RN assists in determining ... reviews as directed in the hospital's Utilization Review Plan and review of medical...necessity. 3. Actively seeks additional clinical documentation from the physician to optimize hospital reimbursement when appropriate. 4. Works… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator Office/On-site Recruitment # 250910-5613FP-001 Location East Hartford, CT Date Opened 9/15/2025 12:00:00 AM Salary $86,261 - ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=)… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …professional development specialist to develop standard work and expectations for the utilization review process, including timely medical necessity ... actions to UR Committees, as appropriate * Partners with Physician Advisor to engage in second level review...with payers, as appropriate * May participate in the Utilization Review Committee to present medical… more
- Sedgwick (Dayton, OH)
- …provider's office. + Utilizes evidence-based criteria and jurisdictional guidelines to form utilization review determinations. + Pursues Physician Advisor ... Fortune Best Workplaces in Financial Services & Insurance RN Utilization Review **PRIMARY PURPOSE** : To provide...+ Identifies treatment plan request(s) and obtains and analyzes medical records that support the request. + Clarifies unclear… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …mentorship, _development,_ and leadership programs + And more **Description** The ** Utilization Review (UR) Specialist** is a Registered Nurse responsible ... for conducting thorough medical necessity reviews to assist with determining appropriate patient...experience or a minimum of two years of previous utilization review experience. + Must have a… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr CMC- Clear...measures to achieve target. + Presents LOS variances for review to Director and Inpatient Medical Director. ... or observation in Community Hospitals and UTMB-TDCJ Hospital. + Performs utilization review procedures by prospectively, concurrently, and retrospectively… 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** + ... provision of quality based patient care focusing on the medical necessity and efficiency of the delivery of such...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Dayton Children's Hospital (Dayton, OH)
- …timeHours:8Job Details:Under the supervision of the Manager of Utilization Management, the Utilization Review RN conducts medical record review for ... appropriateness of inpatient, observation, and extended recovery services following review of relevant medical documentation and ...The Physician Advisor role will support the Utilization Review RN for second level clinical… more
- HonorHealth (AZ)
- …communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation,… 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 ... high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation,… more
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