- Houston Methodist (Houston, TX)
- At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) responsible for promoting the ... objectives delineated in the Utilization Review Nurse and Utilization Review Specialist Nurse job roles and is responsible for facilitating… more
- Trinity Health (Maywood, IL)
- …Position is hybrid, must reside in Illinois. The **Regional Utilization Review Documentation Specialist ** nurse works with the multidisciplinary team ... **Employment Type:** Full time **Shift:** Day Shift **Description:** Utilization Review - RN Reviewer- Regional Coverage for Loyola, Gottlieb and MacNeal… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Vanderbilt University Medical Center (Tullahoma, TN)
- …status is ordered. The nurse conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary review ... difficulty. + Clinical Applications Systems (Novice): Possesses fundamental proficiency in utilization review systems, clinical support systems and business… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by ... Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical/Technical/Service**… 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
- HonorHealth (AZ)
- …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Beth Israel Lahey Health (Cambridge, MA)
- …to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by ... the key performance indicators and quality measures, the RN specialist also aims to foster a culture of safety...reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review … more
- Commonwealth Care Alliance (Boston, MA)
- …for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized ... reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison...Skills & Abilities (must have): * Expertise in managing utilization review processes including prior authorization, concurrent… more
- Cedars-Sinai (Los Angeles, CA)
- …Experience: A minimum of 5 years of experience in Acute Clinical Care, Utilization Review , Coding, or Case Management required Working knowledge of Joint ... for Hiring. **Req ID** : 10457 **Working Title** : Registered Nurse - Clinical Documentation Specialist - 8 Hour Days **Department** : CSRC CDI Services… more
- Hospice of Michigan (Southfield, MI)
- …work with minimal supervision. + Requires knowledge of quality assessment and utilization review functions, principles and practices. + Theoretical and practical ... personnel on the QAPI plan, and team development. + Performs clinical record review activities for data collection. + Compiles, analyzes, trends and reports quality… more
- McLaren Health Care (Port Huron, MI)
- …solving and critical thinking skills. 4. Works with Case Management and Utilization Review regarding potential admissions. 5. Responsible to coordinate infection ... in Nursing (BSN) from an accredited program + Current State of Michigan Registered Nurse license + BLS and/or Canadian equivalent + Minimum two (2) years recent… 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
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Enhanced Care Management Clinical Specialist II Job Category: Clinical Department: Care Management...Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM),… more
- HCA Healthcare (Dallas, TX)
- …acute inpatient rehabilitation services prior to returning home. The Clinical Rehabilitation Specialist will review these patients daily until they have strong ... commitments to referral sources. Develops a call-plan to prioritize utilization of time. + Assists in developing the annual...we encourage you to apply for our Clinical Rehab Specialist opening. We promptly review all applications.… more
- HCA Healthcare (Richmond, VA)
- …acute inpatient rehabilitation services prior to returning home. The Clinical Rehabilitation Specialist will review these patients daily until they have strong ... commitments to referral sources. Develops a call-plan to prioritize utilization of time.** + **Assists in developing the annual...we encourage you to apply for our Clinical Rehab Specialist PRN opening. We review all applications.… more
- UPMC (Pittsburgh, PA)
- …daylight hours. The position will be fully remote! In this role, the DRG Specialist II will review clinical documentation within the medical record to ensure ... UPMC Corporate Revenue Cycle is hiring a DRG Specialist II to join our coding team! This...that all patient resource utilization , diagnostic complications and co-morbidities have been coded in… more
- HCA Healthcare (Nashville, TN)
- …treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile ... any other healthcare provider. We are seeking a(an) Assessment Specialist PRN to join our healthcare family. **Benefits** TriStar...patients in regard to managed care organizations + Conducts utilization review for managed care cases in… more
- HCA Healthcare (Portsmouth, NH)
- …of case review , data abstraction, management and reporting. The Sr. Specialist will actively provide support and carry out assigned functions within the Patient ... quality related committees such as Falls Prevention, Blood Product utilization , etc * Serves as Quality representative for assigned...encourage you to apply for our Sr Clinical Quality Specialist opening. Our team will promptly review … more
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