- Crouse Hospital (Syracuse, NY)
- … staff and/or other health care professionals in accordance with the hospitals Utilization Review guidelines to ensure efficient utilization of health ... Conducts clinical review on cases referred by case management...to practice medicine. Preferred: Additional education in quality and utilization management through continuing medical education programs… more
- CommonSpirit Health (Houston, TX)
- …Candidates licensed in other states will be considered for future openings.** As the Utilization Management Physician Advisor II, the Physician Advisor ... staff ensuring that the system is optimized for effective physician use. The PA helps facilitate training for the...Steering Committee + Extended Length of Stay Rounds + Utilization Review Committee + Care Management… more
- Highland Hospital (Rochester, NY)
- …Physician **Department/Cost Center:** 776 - Quality Assurance **Job Description:** The Utilization Management Physician Advisor is responsible for ... serving the hospital through teaching, consulting, and advising the utilization management department. The Physician ...RN will refer cases to the UM PA for review of inpatient, observation or alternative level of care… more
- CommonSpirit Health (Englewood, CO)
- …of four 10-hour shifts per week, or five 8-hour shifts per week.** As the Utilization Management Physician Advisor (PA), the PA conducts clinical case ... of health care services. The PA communicates remotely with case and utilization management to discuss selected cases and make recommendations regarding level… more
- CommonSpirit Health (Phoenix, AZ)
- …and out in the community. **Responsibilities** This is a remote position. As the Utilization Management Physician Advisor (PA), the PA conducts clinical case ... of health care services. The PA communicates remotely with case and utilization management to discuss selected cases and make recommendations regarding level… more
- Beth Israel Lahey Health (Burlington, MA)
- …resource allocation - Serves as physician expert and provide support to utilization review team regarding utilization decisions pertaining to commercial ... necessity recommendations, as requested Policy Setting Responsibilities Responsible for utilization review and medical necessity recommendations, as requested… more
- Guthrie (Sayre, PA)
- Position Summary: The Utilization Management (UM) Reviewer , in collaboration with other internal and external offices, payors, and providers and staff, is ... responsible for the coordinates Utilization Management (UM) processes and requirements for...prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures authorization as appropriate… more
- Prime Therapeutics (Columbus, OH)
- …- GI- REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do ... needed or required. **Job Description** + Directs daily involvement in the following utilization management functions: + Reviews all cases in which clinical… more
- Evolent Health (Columbus, OH)
- … Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... management staff, other Physicians, and staff whenever a physician `s input is needed or required. As well as,... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Kepro (Los Angeles, CA)
- …for health solutions in the public sector. Acentra seeks aUtilization Clinical Reviewer - LCSW/LMFT/LPCC/LCPC (Remote within California) to join our growing team. ... ensures the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process with the California Mental Health Services Authority (CalMHSA).… more
- Kepro (Lombard, IL)
- …solutions in the public sector. Acentra seeks an Internal Medicine or Family Practice Physician Reviewer (Illinois Remote, PRN) to join our growing team. Job ... Summary: The Internal Medicine or Family Practice Physician Reviewer will provide principal leadership and...and clinical expertise to operations relating to the peer review process, utilization review activities,… more
- Trinity Health (South Bend, IN)
- …authorizations, referrals) and will contact the physician /office and Case Management / Utilization Review colleagues as necessary. Ensures all ... entered on the wrong encounter. Validates complete and accurate documentation by Physician / Utilization Management colleague is met prior to completing… more
- Elevance Health (Nashville, TN)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... state(s) required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-10 + Previous utilization … more
- Elevance Health (San Juan, PR)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... for payment as part of consideration for employment. **Nurse Reviewer I (NCLEX)** + Job Family: MED > Licensed...50 states of the United States. + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- Trinity Health (Livonia, MI)
- …the HMS database of all eligible cases for the hospital. The Clinical Nurse Reviewer also works closely with the physician champion and appropriate hospital ... **Employment Type:** Full time **Shift:** Rotating Shift **Description:** HMS collaborative reviewer The Clinical Nurse Reviewer 's chief responsibility is to… more
- Kepro (Richmond, VA)
- …Behavioral Analyst (LBA) license in the State of Virginia. + 1+ year of Utilization Review (UR) and/or Prior Authorization or related work experience. + 3+ ... + Knowledge of current National Committee for Quality Assurance (NCQA)/ Utilization Review Accreditation Committee (URAC) standards. + Experience… more
- Ellis Medicine (Schenectady, NY)
- …include Director of Quality and Risk, Director of Family Medicine Residency Program, Physician Advisor Utilization Management , and System Wide Chiefs. The ... accordance with Hospital Policy and Procedure, and oversight of physician contract management functions. + Serves as...the budgets of the Clinical Departments. + Provides contractual review for and reviews performance of all physicians who… more
- AdventHealth (Maitland, FL)
- …managed care payers. The Medical Director is responsible for providing physician review of utilization , claims management , and quality assurance related ... need.Collaborates with Senior Medical Officers with contracted managed care payers regarding utilization review management activities and maintain a positive… more
- WMCHealth (Valhalla, NY)
- …role in ensuring physician support and execution of for Utilization Management and Documentation strategies and processes. Responsibilities: + Reviews ... Integrated Case Management including mentoring/coaching care coordinators, utilization review staff and social workers. +...Physician Advisor or having 3-5 years as a Physician Reviewer /Advisor with a third party leveling… more
- Dartmouth Health (Lebanon, NH)
- …Keene is seeking a Physician Advisor (PA) with expertise in Utilization Management , Care Management , and Clinical Documentation. The PA ... Overview Associate Medical Director - Cheshire Hospital Medicine Physician Advisor The Cheshire Medical Center’s Department of...supports Utilization Management by performing concurrent, evidence-based second-level medical necessity reviews,… more