- Appcast (Baltimore, MD)
- …issues. Identifies opportunities for expedited appeals and collaborates with the Care Manager and Physician Advisor to resolve payer issues. Other tasks ... Utilization Review Nurse RN - Grace Medical Center...potential and actual denials and coordinates with nurse Care Manager and/or Social Worker for any follow up necessary.… more
- Sutter Health (Oakland, CA)
- …the acute care patient experience. This position works in collaboration with the Physician , Utilization Manager , Medical Social Worker and bedside RN ... the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self -determination while coordinating… more
- Sutter Health (Roseville, CA)
- …the acute care patient experience. This position works in collaboration with the Physician , Utilization Manager , Medical Social Worker and bedside RN ... the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self -determination while coordinating… more
- Sutter Health (Burlingame, CA)
- …the acute care patient experience. This position works in collaboration with the Physician , Utilization Manager , Medical Social Worker and bedside RN ... the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self -determination while coordinating… more
- Sutter Health (Modesto, CA)
- …the acute care patient experience. This position works in collaboration with the Physician , Utilization Manager , Medical Social Worker and bedside RN ... the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self -determination while coordinating… 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 ... ) required or completed within three years of hire **Title:** * Utilization Review Manager * **Location:** *MN-Minneapolis-Downtown Campus* **Requisition ID:**… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical… more
- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... from payors for additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you...causes of denials for discussion with the internal team, physician advisor and the Utilization Review Committee… more
- Virtua Health (Pennsauken, NJ)
- …than 14,000 colleagues, including over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, ... UR Tech and AA to support UR and revenue cycle process.Position Responsibilities: Utilization Management* Utilizes Payer specific screening tools as a resource to… more
- Catholic Health Services (Melville, NY)
- …for services and coordinates utilization /appeals management review. + Assist Utilization and Appeals Manager in setting up communications with payors ... as a liaison between patient account services, physicians, care coordinators, Utilization and Appeals Managers, physician advisors and facility departments.… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 250924-5613FP-001 Location East Hartford, CT Date Opened 9/30/2025 12:00:00 AM Salary ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=) (Regulatory) position,… more
- University of Utah Health (Salt Lake City, UT)
- …with care team members or third-party payer. + Alerts and discusses with physician /provider and case manager /discharge planner when patient no longer meets ... advancement, and overall patient outcomes. **Responsibilities** + Applies approved utilization criteria to monitor appropriateness of admissions with associated… more
- Dayton Children's Hospital (Dayton, OH)
- …Utilization Review TeamSchedule:Full timeHours:40Job Details:Under the supervision of the Manager of Utilization Management, the Utilization Review ... a resource to the physicians, collaborates with the Care Manager in the development and implementation of the plan...team assisting to prevent concurrent and retrospective denials. The Physician Advisor role will support the Utilization … more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- Swedish Health Services (Seattle, WA)
- …role. You MUST live in the state of Washington (WA) to be considered_** **Care Manager RN** **Per diem / On call** **Day shift** The Utilization Review (UR) ... clinical background blended with a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This… more
- Beth Israel Lahey Health (Plymouth, MA)
- …improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Beth Israel Lahey Health (Plymouth, MA)
- …improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …clinical documentation integrity, and identification of trends in the over and under- utilization of resources. 2. The Physician Advisor should be a ... related to quality care of patients, regulatory compliance, and utilization management (including LOS). 4. The Physician ...resources to achieve optimal outcomes * Notify the case manager of any conflict of interest in reviewing a… more
- HonorHealth (AZ)
- …PA further acts as a resource for the medical staff regarding federal and state utilization and quality regulations. As a CDI physician advisor, the PA will act ... Care Management in a data-driven approach. Notifies the care manager of any conflict of interest in reviewing a...as assigned Education + MD or DO Board Certified Physician with a special interest in Utilization … more
