- Bassett Healthcare (Cooperstown, NY)
- …continuous improvement in both areas. + Refers cases and issues to Case Review , Utilization Committee, Medical Director , and Director of Quality in ... and accurate information to payors. The role integrates and coordinates utilization management, care facilitation, and discharge planning functions. The Case Manager… more
- UPMC (Pittsburgh, PA)
- The UPMC Health Plan is seeking a licensed MD or DO for a fully remote Medical Director , Utilization Management role. The Medical Director , ... full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including concurrent,… more
- Elevance Health (Wallingford, CT)
- ** Utilization Management Medical Director -...Medical Director ** will be responsible for utilization review case management for North Carolina ... opportunities. May serve as a resource to staff including Medical Director Associates. **How you will make...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- 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
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... Director , Utilization Management + Oakland, CA...reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview:** The Medical Director , Utilization Management, provides organizational leadership in the operational areas of appeals, utilization ... policy and practice initiatives in collaboration with the Corporate Medical Directors, Utilization Management and the Vice President, Medical Affairs.… more
- Tufts Medicine (Burlington, MA)
- …coordinates the design, development, implementation, and monitoring of the organization's utilization review functions. The position establishes the department's ... the utilization of resources, coordination of care across the continuum and utilization review and management. The position develops and leads the … more
- Wellpath (Lemoyne, PA)
- …training, education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees ... to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... Overview AtCentinela Hospital Medical Center, our dedicated team of professionals are...part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case… more
- Actalent (Sunrise, FL)
- …in collaboration with the interdisciplinary team, the UMN handles tasks related to utilization review across various specialties, medical treatments, and ... Job Title: Behavioral Health Utilization Review NurseJob Description The ...using standardized Review Criteria. + Coordinate with Medical Director /Physicians for requests outside of standard… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …professional development specialist to develop standard work and expectations for the utilization review process, including timely medical necessity ... trends for opportunities to improve services. Partners with hospital Director Transitional Care to report avoidable days, trends, and...with payers, as appropriate * May participate in the Utilization Review Committee to present medical… more
- UTMB Health (Galveston, TX)
- Utilization Review Case Mgr - Galv. Campus Utilization Mgt (10hr shifts) **Galveston, Texas, United States** **New** Nursing & Care Management UTMB Health ... and criteria guidelines. **MAJOR DUTIES / CRITICAL TASKS:** + Implements Utilization review procedures by prospectively, concurrently, and retrospectively… more
- Behavioral Center of Michigan (Warren, MI)
- Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex ... and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart...all tasks requested by the UR Manager, CEO or Medical Director to meet the needs of… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... provision of quality based patient care focusing on the medical necessity and efficiency of the delivery of such...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Idaho Division of Human Resources (Nampa, ID)
- …can be found here: https://dhr.idaho.gov/StateEmployees/Benefits.html.* EXAMPLE OF DUTIES: + Coordinate Utilization Review Services to assess medical ... Utilization Review and Nurse Educator -...across Idaho. Under the direction and supervision of the Director of Performance Improvement and Accreditation, this position is… more
- UCLA Health (Los Angeles, CA)
- Description Under the direction of the Assistant Director , the ICM Medicare Advantage Utilization Review Nurse performs utilization review of ... population enrolled under UCLA Medical Group. The ICM Medicare Advantage Utilization Review Nurse ensures that home health and durable medical equipment… more
- Monte Nido (Miami, FL)
- …authorization, potential denials, and potential for private payment. + Follow workflow and medical record requirements for utilization review and clinical ... while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... actions to achieve continuous improvement in both areas.* Refers cases and issues to Medical Director and Triad Team in compliance with Department procedures and… more
- Martin's Point Health Care (Portland, ME)
- …requests (prior authorization, concurrent review , and retrospective review ) for medical necessity referring to Medical Director as needed for ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member...Utilize evidenced-based criteria, governmental policies, and internal guidelines for medical necessity reviews. + Manage the review … more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
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