- New York State Civil Service (Bronx, NY)
- NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), New York City Children's Center - Bronx Campus, P25595 Occupational ... New York City Children's Center - Bronx Campus is recruiting for a Utilization Review Coordinator to analyze and evaluate quality, effectiveness, and efficiency… more
- Houston Methodist (The Woodlands, TX)
- …needs for the department and the hospital. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource use, ... for the hospital. + Secures reimbursement for hospital services by communicating medical information required by all external review entities, managed care… more
- Sedgwick (Salt Lake City, UT)
- …Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Physical Therapy Utilization Review Advisor **For client coverage; prefer someone in ... updated with relevant industry regulations, guidelines, and best practices related to utilization review and maintains compliance with applicable laws and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …with Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise ... position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and...regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and… more
- Tufts Medicine (Burlington, MA)
- …**Job Overview** The position provides day to day support and oversight to Utilization Review departments and UM vendor management. Responsible for compliance ... hours as needed. **Location:** Primarily remote. May require occasional travel to local facilities including Tufts Medical ...with CMS Conditions of Participation regarding Utilization Review and Discharge Planning including implementation… more
- LifeCenter Northwest (Bellevue, WA)
- Organ Utilization Coordinator Job Details Job Location Bellevue - Bellevue, WA Position Type Full Time Salary Range $75918.00 - $110112.00 Salary Job Posting Date(s) ... Start Date 04/09/2025 Description and Qualifications The Organ Utilization Coordinator (OUC) is accountable for overseeing all activities related to the allocation… more
- Humana (Louisville, KY)
- … utilization management staff; direct performance regarding prior authorization, medical necessity determinations, concurrent review , retrospective review ... community and help us put health first** The Associate Director, Utilization Management utilizes clinical nursing skills to support the coordination, documentation… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Ascension Travel Program & Interim Leadership + **Schedule:** Full-time, Days + **Hospital:** Ascension St. Thomas + **Location:** ... Please consult with your Recruiter to learn more. Will serve as an Interim Travel Nursing leader with the potential to serve various Ascension hospitals. For more… more
- Humana (Frankfort, KY)
- …and help us put health first** The Manager, Behavioral Health Utilization Management uses clinical knowledge, communication skills, and independent critical thinking ... department. **_Detailed Responsibilities include:_** Leads Kentucky Medicaid Behavioral Health Utilization Management process and teams responsible for supporting **_Behavioral… more
- Ascension Health (Nashville, TN)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured clients to ... **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40...**Location:** Remote - Nashville, TN. This position requires occasional travel to Ascension Saint Thomas hospitals throughout the TN… more
- McLaren Health Care (Detroit, MI)
- … records/billing or healthcare related field + Two years of case management or utilization review , billing, or coding experience + Three years of recent ... determine the appropriate hospital setting (inpatient vs. observation) based on medical necessity. 2. Performs concurrent and retrospective utilization … more
- CoreCivic (Brentwood, TN)
- …pay $82,000 - $97,400 with a 10% bonus eligible._ **SUMMARY:** The Manager, Utilization Management/Case Management provides Utilization Review and Case ... and approving leave requests. + Collaborates with management for oversight of the utilization review process to ensure services being rendered are appropriate… more
- Humana (Columbus, OH)
- …and external customers and stakeholders. **Preferred Qualifications** + Experience with utilization review process. + Experience with behavioral change, health ... and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization … more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …external facility or providers as needed to gather clinical information to support the medical necessity review process and plan of care. + Support a positive ... Conduct pre-certification, concurrent, and retrospective reviews with emphasis on utilization management, discharge planning, care coordination, clinical outcomes, and… more
- Katmai (Fort Carson, CO)
- …need for inpatient/outpatient precertification. **ESSENTIAL DUTIES & RESPONSIBILITIES** + Review precertification requests for medical necessity, referring to ... Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part...Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,… more
- Geisinger (Danville, PA)
- …information, suggests alternatives and assists in ensuring documentation integrity. + Enters utilization review data into database for tracking and trending ... Job Duties The RN Clinical Access Specialist performs initial, concurrent and retrospective medical record review to determine medical necessity for acute… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you to apply! Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. ... fax for inpatient and outpatient procedures, behavioral health, and durable medical equipment. Essential Accountabilities: Level I + Facilitates inbound and outbound… more
- Molina Healthcare (San Jose, CA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or...as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only). Must be able to travel… more
- Sharp HealthCare (San Diego, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... administered including two (2) patient identifier verification. Assists with Medical Assistant medication verification in immediate area. No medication errors.Able… more
- Molina Healthcare (San Diego, CA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE** **_3-12 DAY SHIFT: 7:30AM - 08:30PM...requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and… more
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