- Trinity Health (Stafford Springs, CT)
- …time **Shift:** Day Shift **Description:** RN or Social Worker **Position Purpose** The Utilization Management Specialist is responsible for acute care ... (Medical Records) and Admitting, to provide pertinent data relating to utilization management / clinical resource management issues and questions **Minimum… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
- Penn Medicine (Lancaster, PA)
- …each day. Are you living your life's work? Summary: + Position Summary: The Utilization Management Specialist - Denials is responsible for evaluating medical ... insurance benefit structures and related legal medical issues. + Knowledge of utilization management and quality improvement processes. + Experience working… 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 ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Penn State Health (Hershey, PA)
- …###@pennstatehealth.psu.edu (MAILTO://###@pennstatehealth.psu.edu) Penn State Health is seeking a dedicated ** Utilization Management Specialist ** to join our ... SEIU Healthcare Pennsylvania **Position** Specialist (Part-time) - VARIED SHIFTS - Utilization Management **Location** US:PA: Hershey | Nursing | Part Time… more
- Sanford Health (SD)
- …Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to ... potentially, prior authorization. Assists the department in monitoring the utilization of resources, risk management and quality...in monitoring the utilization of resources, risk management and quality of care for patients in accordance… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Utilization Management Specialist , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: ... to be named a Forbes "Best Employer" seven times. Position Summary: The Utilization Management Specialist I will perform utilization management … more
- Sharp HealthCare (San Diego, CA)
- …and employer business practices. **What You Will Do** The Provider Relations Specialist is responsible for the development and maintenance of positive working ... Qualifications** + Bachelor's Degree Business, marketing, or health care management . **Other Qualification Requirements** + Utilizes reliable transportation and… more
- BriteLife Recovery (Englewood, NJ)
- …compliance. + Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in denials, approvals, ... What you will be doing? The Utilization Review (UR) Specialist is a...you? + Minimum of 2-3 years of experience in utilization review, case management , or insurance coordination… more
- Reno Behavioral Healthcare Hospital (Reno, NV)
- …an interdisciplinary approach to support continuity of care. + Provides utilization management , transfer coordnation, discharge planning, and issuance of ... The UR Specialist reviews and monitors patients' utilization ...and quality of care. + Responsible for the proactive management of patients with the objective of improving quality… 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 of ... of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary services. Responsible for coordinating and conducting medical… more
- Spectrum Billing Solutions (Skokie, IL)
- …cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing team. The UR Specialist ... and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for treatment… more
- 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
- St Joseph's Addiction Treatment & Recovery Centers (Saranac Lake, NY)
- …Centers Location: Inpatient Facility - Saranac Lake, NY Position: Full-time Utilization Review Specialist Shift/schedule: Monday-Friday, 8:00am-4:30pm Pay Range: ... and coordinate account card reimbursements, if necessary. + Support behavioral utilization activities, aligning with agency policies to promote optimal client care… more
- Great River Health (West Burlington, IA)
- …responsible for maintaining compliance with the CMS Conditions of Participation for Utilization Management .What you will do + Review inpatient encounters for ... delivery.-Adhere to all state and Federal regulations for all UM reviews.-Practice utilization management activities within the scope of practice. + Excellent… more
- Nuvance Health (Danbury, CT)
- *Description* Summary: Required- Registered Nurse ( RN) The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary team, ... of care and providing timely and accurate clinical information to payors. Utilization management provides clinically based first level medical necessity reviews… more
- ManpowerGroup (Rancho Cucamonga, CA)
- Our client, a leading healthcare organization, is seeking a Coordinator - Utilization Management Outpatient to join their team. As a Coordinator - Utilization ... Management Outpatient, you will be part of the Utilization Management Department supporting the healthcare team....three (3) years of experience as a data entry specialist or coordinator. + High school diploma or GED… more
- Intermountain Health (Las Vegas, NV)
- …interacts with MG clinicians, Affiliate Network PCPs and Specialists in the community, utilization management , care management , claims, network management ... finance. As the Medical Director for Utilization Management , you are responsible, in partnership with MG Clinical... Initiatives here. Co-manage several on-going work groups with Specialist groups in Las Vegas to further the causes… more
- Katmai (Fort Carson, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... background checks. **DESIRED QUALIFICATIONS & SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in Healthcare… more
- Sanford Health (WI)
- …**Weekly Hours:** 40.00 **Salary Range:** $21.50 - $28.00 **Job Summary** Monitors the utilization of resources, risk management and quality of care for patients ... multiple administrative duties including accurate record keeping and electronic data management when needed. Ability to work with growth and development needs… more
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