- Prime Healthcare (Garden Grove, CA)
- …coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for ... and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely with… more
- Prime Healthcare (Chino, CA)
- …coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for ... Document and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working… more
- Prime Healthcare (Joliet, IL)
- …coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for ... Overview Department: Utilization Management / Social Work Services Schedule:...all related correspondence to the respective EMR/ tracking tool. Utilization review tech will follow up on… more
- Baptist Memorial (Memphis, TN)
- …obtaining authorizations, claims review , patient billing, appeal writing, auditing, and/or denial management ; 3-5 years case management experience, or ... accredited nursing program Training Description Minimum Required Preferred/Desired Nursing, Case Management or Denial Management . Familiarity with electronic… more
- Baptist Memorial (Memphis, TN)
- …obtaining authorizations, claims review , patient billing, appeal writing, auditing, and/or denial management ; 3-5 years case management experience, or ... accredited nursing program Preferred/Desired Training Description Minimum Required: Nursing, Case Management or Denial Management . Familiarity with… more
- Premier Health (Dayton, OH)
- …of job related experience** **Prior job title or occupational experience: Case management , Utilization review ** Preferred experience: Knowledge of hospital ... and expertise in process analysis, clinical outcome data analysis, utilization management , and utilization of...and Medicaid guidelines, and other regulations which impact the utilization or denial of provider services. Essential… more
- Baylor Scott & White Health (Dallas, TX)
- …+ Worked on the payer (Insurance) side of appeals and denials. + Experience in Utilization Review and Case Management . **Essential Functions of the Role** + ... **Job Summary** You, as a Registered Nurse in the Denial Resource Center at Baylor Scott & White Health,...earnestly participating in their implementation. + By closely examining denial trends, you will categorize them based on impacts… 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 ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management ...they pertain to level of care determination and the appeal/ denial process. + Oversees utilization review… more
- Tenet Healthcare (Detroit, MI)
- …and advance Tenet’s Case Management strategy with the specific focus on Utilization Review for the designated Market. Will support the advancement of ... initiatives and will provide subject matter expertise for Case Management – Utilization Review regulations...of daily operations of the UM team and optimizing denial mitigation processes. Will partner with the Group DCM… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,...state, local, and federal programs + Progressive knowledge of utilization management , case management , performance… more
- The County of Los Angeles (Los Angeles, CA)
- …for the issuance of denial letters. + Reviews, retrospectively, utilization review records for completeness, use of appropriate codes, correctness ... UTILIZATION REVIEW NURSE SUPERVISOR I Print...Review Nurse is an RN that has Case Management experience whose primary charge is to ensure that… more
- AmeriHealth Caritas (Dover, DE)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… more
- Catholic Health Initiatives (Omaha, NE)
- **Responsibilities** Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact patient care and optimize ... our patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! As our… more
- Trinity Health (Des Moines, IA)
- …of the interactions in the STAR admitting system. ESSENTIAL FUNCTIONS: + Conducts admission review per the Utilization Management Plan to ensure that the ... the MercyOne Family! We are looking to hire a Utilization Review RN! Responsible for the ...of the change. + Documents in the Medical Record Utilization Management forms accurately to reflect the… more
- Prime Healthcare (Ontario, CA)
- …coordinate the utilization review and appeals process as part of the denial management initiatives. This position will also serve as a liaison and own ... education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/185727/ utilization - review -technician-iii/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management… more
- Baptist Memorial (Meridian, MS)
- …Minimum Required: RN with 3 years of clinical experience Preferred/Desired: RN with Case Management or Utilization Review experience in a hospital or payer ... Overview RN Utilization Review Weekender Job Code: 22818...management , medical necessity reviews, verification of authorization, resource utilization , and denial prevention. Job Responsibilities +… more
- Baptist Memorial (Memphis, TN)
- …Minimum Required Preferred/Desired RN with 3 years of clinical experience RN with Case Management or Utilization Review experience in a hospital or payer ... Overview Job Summary The Utilization Review Nurse is responsible for...management , medical necessity reviews, verification of authorization, resource utilization , and denial prevention. Job Responsibilities *… more
- Catholic Health Services (Melville, NY)
- …queries from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, ... to remain current with industry standards and business objectives related to Utilization and Care Management as appropriate. Sound knowledge and skill… more
- Scottish Rite for Children (Dallas, TX)
- …giving children back their childhood! Job Posting Title: Case Manager and Utilization Review Coordinator Location: Dallas - Hospital Additional Posting Details: ... effective communication with patient care team members related to utilization management + Verify medical necessity of...and other areas as assigned + Serve on the Utilization Review Committee for the Scottish +… more
- Ochsner Health (New Orleans, LA)
- …of stay management and utilization of resources + Assist with the denial management process + Review medical records of patients identified by case ... at Ochsner Health and discover your future today!** The Physician Advisor (PA- Utilization Management ) serves as the physician leader in matters relating… more