• Physician Advisor - Utilization

    Ochsner Health (New Orleans, LA)
    …Come make a difference at Ochsner Health and discover your future today!** The Physician Advisor (PA- Utilization Management ) serves as the physician ... Interdisciplinary and Post-Acute teams, Payors, Administration and Revenue Cycle) to improve utilization management , sustain quality goals, and act as a… more
    Ochsner Health (04/09/25)
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  • Physician Advisor Denials Management

    CommonSpirit Health (Phoenix, AZ)
    …a more just, equitable, and innovative healthcare delivery system. **Responsibilities** The Utilization Management Physician Advisor II (PA) conducts ... team, medical staff, and medical executives to encourage physician cooperation and understanding of documentation importance + Assists...such as Joint Operating Committee (JOC), as requested by Utilization Management or Care Management .… more
    CommonSpirit Health (04/11/25)
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  • Physician Advisor

    CommonSpirit Health (Houston, TX)
    …a remote position and you must be licensed in the state of Texas. As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews ... care services. The PA communicates remotely with case and utilization management to discuss selected cases and...+ Minimum of 1 year of experience as a Physician Advisor preferred. + Minimum of 5 years of… more
    CommonSpirit Health (04/30/25)
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  • Group Utilization Review Director

    Tenet Healthcare (Detroit, MI)
    …financial outcomes Utilizes data to provide timely and meaningful information to the Utilization Management Committee and physician staff for performance ... to Case Management scope of services, including utilization management , transition management promoting...resources in advocating for patient needs with judicious resource management Oversees submission of cases to Physician more
    Tenet Healthcare (04/20/25)
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  • Coord Physician Adv Ops

    Covenant Health Inc. (Knoxville, TN)
    …Operations Coordinator will perform activities to help facilitate utilization management functions related to the coordination of physician advisor related ... to denials. + Maintains a monthly data report on each physician 's activities impacting Utilization Management activities. + Manages physician advisor… more
    Covenant Health Inc. (05/02/25)
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  • Medical Director - Utilization

    UPMC (Pittsburgh, PA)
    The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
    UPMC (04/03/25)
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  • Physician Advisor, Utilization

    Sutter Health (Sacramento, CA)
    …Advisor will work closely with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management (CM) personnel to ... health care services. The PA will develop expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical… more
    Sutter Health (03/21/25)
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  • Utilization Review Specialist

    Nuvance Health (Danbury, CT)
    …Summary: Required- Registered Nurse ( RN) The purpose of the Utilization Management Nurse is to support the physician , the interdisciplinary team, and ... of care and providing timely and accurate clinical information to payors. Utilization management provides clinically based first level medical necessity reviews… more
    Nuvance Health (04/23/25)
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  • Physician Advisor

    Ascension Health (Baltimore, MD)
    …5 years of recent experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experince. This position reports to ... **Details** + **Department** : Case Management + **Schedule:** Full Time | Hybrid (frequently...**Position Highlights:** Ascension St. Agnes is looking for a Physician Advisor to join our team. We are looking… more
    Ascension Health (04/08/25)
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  • Physician - Physician Advisor

    Ascension Health (Jacksonville, FL)
    …5 years of recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are ready ... **Details** + **Department** : Case Management + **Schedule:** Full Time | Hybrid (frequently...**Position Highlights** Ascension St. Vincent is looking for a Physician Advisor to join our team. We are looking… more
    Ascension Health (04/24/25)
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  • Physician - Physician Advisor

    Ascension Health (Hoffman Estates, IL)
    …years of recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. This position reports ... **Details** + **Department** : Case Management + **Schedule:** Full Time | Onsite +...**Position Highlights** Ascension St. Alexius is looking for a Physician Advisor to join our team. We are looking… more
    Ascension Health (03/04/25)
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  • Physician - Physician Advisor

    Ascension Health (Austin, TX)
    …5 years of recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are ready ... **Details** + **Department** : Case Management + **Schedule:** Full Time | Hybrid (frequently...**Responsibilities** **Position Highlights** Ascension Seton is looking for a Physician Advisor to join our team. We are looking… more
    Ascension Health (02/13/25)
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  • CHS Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as required. Communicates ... changes from the Managed Care Department and applies to UM and appeals management processes. Works collaboratively with physicians, physician office staff and… more
    Catholic Health Services (03/19/25)
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  • Director Physician Advisor

    Catholic Health Services (Melville, NY)
    … Advisors during the monthly Physician Advisor meeting. Attends hospital Utilization Management (UM) committees. Supervises the Facility Physician ... develops standard system-wide implementation plans and policies. Works with system Care Management (CM) leadership and Catholic Health Physician Advisors (as… more
    Catholic Health Services (03/05/25)
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  • HPS Provider Svc Specialist (Remote & Onsite)

    Parkview Health (Fort Wayne, IN)
    …in managed healthcare, provider relations, project management , medical informatics, utilization management or physician office experience. Other ... outside the office approximately 5% of the time. Must demonstrate excellent time management skills and leverage opportunities to work hybridly from home or the… more
    Parkview Health (03/08/25)
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  • Physician Utilization Review…

    Hackensack Meridian Health (Hackensack, NJ)
    …population and Hackensack UMC. These include but are not limited to utilization review, hospital reimbursement, clinical compliance, case management , and ... The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of… more
    Hackensack Meridian Health (04/22/25)
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  • Pre-Service Specialist - Full-Time

    Trinity Health (South Bend, IN)
    …entered on the wrong encounter. Validates complete and accurate documentation by Physician / Utilization Management colleague is met prior to completing ... (pre-certifications, third party payer authorizations, referrals) and will contact the physician /office and Case Management / Utilization Review colleagues as… more
    Trinity Health (03/14/25)
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  • Utilization Management Reviewer…

    Excellus BlueCross BlueShield (Utica, NY)
    …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
    Excellus BlueCross BlueShield (05/02/25)
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  • Vice President, Chief Medical Officer…

    BJC HealthCare (St. Louis, MO)
    physician behavior, physician education, physician leadership, physician advisors, utilization management , margin stabilization work that affects ... physician behavior, physician education, physician leadership, physician advisors, utilization management , margin stabilization work that affects… more
    BJC HealthCare (03/10/25)
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  • System Utilization Management SUM…

    Alameda Health System (Oakland, CA)
    System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + ... + Req #:41909-31047 + FTE:1 + Posted:April 28, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible for… more
    Alameda Health System (05/02/25)
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