- UNIVERSITY HEALTH (San Antonio, TX)
- …Diagnosis and Procedure Coding on all cases. Trains new Coding Specialist (s), Technician(s), and Associate(s). Promotes the Health System's guest relations' policy. ... that promotes Healthcare Effectiveness Data and Information Set (HEDIS) metrics, Utilization Review Accreditation Commission (URAC), and the Joint Commission (TJC).… more
- University of Wisconsin - Stout (Menomonie, WI)
- …initiatives, the archivist partners with the Archivist & Digital Publishing Specialist to ensure the long-term preservation and discoverability of institutional ... and accessioning of new materials, ensuring proper documentation and rights management . Instructional and Research Support (20%) Provides reference services to… more
- Cleveland Clinic (Cleveland, OH)
- …career with one of the most respected healthcare organizations in the world. As a Utilization Management Specialist , you will perform UM activities, such as ... discharge plan. + Achieve a minimum of 85% on IRR quarterly. + Complete Utilization Management for assigned patients with a minimum of 25-30 reviews per day. +… more
- Penn State Health (Hershey, PA)
- …or outlaw discrimination._ **Union:** SEIU Healthcare Pennsylvania **Position** RN Registered Nurse Utilization Management Specialist - Utilization ... for maintaining compliance with the CMS Conditions of Participation for Utilization Management . **MINIMUM QUALIFICATION(S):** + Bachelors Degree in Nursing… 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
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... Preferred **Experience:** 5 years Clinical nursing experience. 2 years Care Management and/or Utilization Management . **Preferred Qualifications:** + … more
- Spectrum Billing Solutions (Skokie, IL)
- …mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist | UR Specialist | Revenue ... Specialist | ABA Utilization Review Specialist | ABA Utilization Management Specialist | ABA UR Specialist | Behavioral Health Billing … more
- AnMed Health (Anderson, SC)
- …here. This position is responsible for performing the daily operations of the Utilization Management program at AnMed within the Care Coordination model. These ... necessity review, continued stay/concurrent review, retrospective review, bed status management , resource utilization management , regulatory compliance,… more
- Sanford Health (Sioux Falls, 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
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Quality Reporting and Auditing Specialist I Job Category: Clinical Department: Utilization Management Location: Los Angeles, ... the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Quality Reporting and Auditing Specialist I is responsible… more
- UnityPoint Health (Cedar Rapids, IA)
- …Adolescent Treatmt/Child S + Shift: 0900-1700 + Job ID: 174223 Overview The Utilization Management Specialist in the Behavioral Health Hospital Outpatient ... optimal clinical outcomes and patient and provider satisfaction. The UM Specialist provides the Utilization Management function for patients admitted to BH… more
- Houston Methodist (Houston, TX)
- …Provides education to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of department scores for ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position...state, local, and federal programs + Comprehensive knowledge of utilization management , case management , performance… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... **Job Summary** The Part-Time Clinical Utilization Review Specialist is responsible for...extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key… more
- CaroMont Health (Gastonia, NC)
- …to MCO via fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments, ... liaison to managed care organizations. Communicates with attending physicians regarding utilization issues. Collaborates with discharge planning specialist 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
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe 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
- 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
- YesCare Corp (Brentwood, TN)
- …as indicated. + Communicate and guide staff and physicians regarding utilization management program development, implementation, and evaluation and ... Nurse (RN) active license + No less than 5 years' experience in utilization management , case management , quality management . + Experience with InterQual… more
- Sharp HealthCare (San Diego, CA)
- …will track and maintain this certification.For Sr Spec ICM assigned to Utilization Management , Train-the-Trainer certification may substitute for ACM or CCM. ... will track and maintain this certification.For Sr Spec ICM assigned to Utilization Management , Train-the-Trainer certification may substitute for ACM or CCM.… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- …a web-based application for daily entry of case activity and the utilization management of service authorizations. Educational and Experience Requirements: MA/MS ... $65,000/year Position Summary: The UM Program Manager provides oversight and management of service authorization data validation, reporting and trend analysis… more
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