- Hackensack Meridian Health (Hackensack, NJ)
- The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Emory Healthcare/Emory University (Duluth, GA)
- …with the attending physician and/or physician advisor. + The UR Specialist will perform utilization review by completing a timely and comprehensive ... _development,_ and leadership programs + And more **Description** The Utilization Review (UR) Specialist is...ensure the continuity of patient care. + The UR Specialist serves as a resource to the Physician… more
- Bakersfield Behavioral Healthcare Hospital (Bakersfield, CA)
- …leadership, teamwork, and communication skills. ESSENTIAL DUTIES The primary responsibility of the Utilization Review Specialist is to review medical ... of candidates. Education Associates Degree preferred Minimum Work Experience Utilization Review experience preferably in a behavioral/psychiatric healthcare… more
- Nuvance Health (Danbury, CT)
- …any issues/denials to department leadership.* * 12) Forwards reviews that require secondary physician review to appropriate resource ( Physician Advisor) 13) ... Required- Registered Nurse ( RN) The purpose of the Utilization Management Nurse is to support the physician...as required. Education: ASSOCIATE'S LVL DGRE Preferred- Two Years Utilization Review Experience Required- Registered Nurse (… more
- HonorHealth (Scottsdale, AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The 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
- Medical Center Hospital (Odessa, TX)
- Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician Advisors. Education: Holds a current Texas license as a… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Trinity Health (Stafford Springs, CT)
- …RN or Social Worker **Position Purpose** The Utilization Management Specialist is responsible for acute care concurrent review authorizations, denials ... of severity of illness (profiling) by working with the physician in the concurrent review process. May...Records) and Admitting, to provide pertinent data relating to utilization management / clinical resource management issues and questions… more
- Intermountain Health (Las Vegas, NV)
- …1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims review , quality ... with MG clinicians, Affiliate Network PCPs and Specialists in the community, utilization management, care management, claims, network management, and finance. As the… more
- Catholic Health Initiatives (Omaha, NE)
- …innovative healthcare delivery system. **Responsibilities** Are you a skilled and experienced Utilization Review Specialist looking for a rewarding ... our patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! As our… more
- Sanford Health (WI)
- …also acceptable, ie Certified Coding Specialist (CCS), Certified Coding Specialist - Physician based (CCS-P), Certified Professional Coder (CPC), Certified ... **Salary Range:** $21.50 - $28.00 **Job Summary** Monitors the utilization of resources, risk management and quality of care...is not exceeded without due notice to the attending physician . May also need to notify physician … more
- Covenant Health Inc. (Knoxville, TN)
- …and financial data to various audiences as necessary. + Completes daily work lists for utilization review meeting the time frames set forth by Covenant Health. + ... Overview Utilization Management Specialist , Revenue Integrity and...ensure timely follow through for status placement. The UM Specialist collaborates with attending physician if ambiguous… more
- Mohawk Valley Health System (Utica, NY)
- … regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of...and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides… more
- HCA Healthcare (Derry, NH)
- …and personal growth, we encourage you to apply for our Provider Solution Specialist opening. We promptly review all applications. Highly qualified candidates ... today.** **Introduction** Do you have the career opportunities as a Provider Solution Specialist you want with your current employer? We have an exciting opportunity… more
- HCA Healthcare (Denver, CO)
- …and personal growth, we encourage you to apply for our Provider Solutions Specialist II opening. We promptly review all applications. Highly qualified candidates ... hours volunteering in our communities. As a Provider Solutions Specialist II with HCA HealthOne you can be a...II (PSS II)applies advanced knowledge to problem resolution for physician -facing technologies. They serve as an escalation point for… more
- Baptist Memorial (Memphis, TN)
- …BMHCC. Physician Advisor communication may be necessary to provide further clinical review from the physician perspective as needed in preparation of writing ... Overview Specialist -Denial Mitigation II RN Job Code: 21432 FLSA...clinical meetings, reach out to payer contacts, communicate with physician clinics to obtain additional documentation to support appeal,… more
- Baptist Memorial (Memphis, TN)
- …BMHCC. Physician Advisor communication may be necessary to provide further clinical review from the physician perspective as needed in preparation of writing ... Overview Specialist -Denial Mitigation II RN Job Code: 21432 FLSA...clinical meetings, reach out to payer contacts, communicate with physician clinics to obtain additional documentation to support appeal,… more
- Veterans Affairs, Veterans Health Administration (Fayetteville, NC)
- …improvement certification. Current mastery level certifications include: Certified Coding Specialist (CCS),Certified Coding Specialist - Physician -based ... medical data from patient health records in the hospital setting, and/or physician -based settings, such as physician offices, group practices, multi-specialty… more
- HCA Healthcare (Dallas, TX)
- …staff performance evaluations. + Acts as manager in charge as assigned. + Provides review and guidance on physician order sets and other evidenced based ... in daily multidisciplinary and bedside rounds + Completes drug utilization reviews to promote rational drug therapy and implement...we encourage you to apply for our Clinical Pharmacist Specialist BMT PRN opening. We promptly review … more
- Stanford Health Care (Palo Alto, CA)
- …one (1) year of experience as a licensed advanced practice provider: ( Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or Certified Registered ... Provides clinical direction and education, works closely with operational and physician leaders, and has oversight of hiring, termination, and professional growth… more
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