- Prisma Health (Maryville, TN)
- …of care and timely implementation of plan of care in accordance with hospital(s) Utilization Review Plan and CMS regulation. Maintains expert level knowledge of ... timely contacts with insurers to provide clinical information to support physician referrals. In collaboration with physicians, leads the multidisciplinary team… more
- Alameda Health System (Oakland, CA)
- …for patients, improve the quality of patient care and maximize the efficient utilization of physician and hospital resources. Report to departmental leadership ... Emergency Medicine Physician + Oakland, CA + Highland General Hospital...with EM Chair and or Vice Chair annually to review yearly goals and expectations. **MINIMUM QUALIFICATIONS** : Education:… more
- Stanford Health Care (Palo Alto, CA)
- …provides clinical direction and education, works closely with operational and physician leaders, and has oversight of hiring, termination, and professional growth ... Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), or the Physician Assistant (PA) Job Description approved by the Interdisciplinary Practice… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …results-driven **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical directors/ physician reviewers, network physicians, and ... evenings and weekends, to address pharmacy-related denials + Educates physician reviewers and clinical review staff on...license + 3+ years Nursing experience + 1+ years Utilization Management and Appeals experience + Excellent verbal, written… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more
- Stanford Health Care (Palo Alto, CA)
- …Provides clinical direction and education, works closely with operational and physician leaders, and has oversight of hiring, termination, and professional growth ... Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), or the Physician Assistant (PA) Job Description approved by the Interdisciplinary Practice… more
- CoxHealth (Lake Spring, MO)
- …Job Summary ◦ This position is responsible for facilitating timely and accurate physician documentation in the medical record through concurrent chart review . ... team regarding proper clinical documentation utilizing approved guidelines. Understand and utilization of ICD-10-CM and PCS coding assignment and follow Official… more
- Stanford Health Care (Palo Alto, CA)
- …for changes in process and operations to include standardization and utilization of resources (supplies, equipment, services, people, etc.). The Category Manager ... of the SHC & LPCH Value Based Selection group, which is a physician led multi-specialty committee that evaluates all requests for new products and technology.… more
- Valero (San Antonio, TX)
- …the data center. * Provide management, monitoring, and optimization of power utilization , HVAC requirements and capacity planning for Valero data center. * Provide ... of electrical devices and energy consumption to maintain efficient and safe utilization of Valero data center facilities. * Coordinate the acquisition, location… more
- Battelle Memorial Institute (Oceanside, CA)
- …and current notes in the electronic medical records of all patients contacted for review by the managing physician + Routinely staff difficult cases with the ... will support positive programs for equal treatment of all staff and full utilization of all qualified employees at all levels within Battelle._ The above statements… more
- Katmai (Fort Carson, CO)
- …procedures, treatments and medications are administered in accordance with (IAW) physician orders, sound nursing judgment and applicable guidelines. + Accurately ... all levels of health care management to include outside agencies. Performs utilization management activities to optimize cost, quality, and access to care. Adhere… more
- Hackensack Meridian Health (Hackensack, NJ)
- The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical ... Hackensack University Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… 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
- CommonSpirit Health (Phoenix, AZ)
- …by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. + Physician Advisor Sub-specialty Certification ... This role will be an expert on matters regarding physician practice patterns, over and under- utilization of...by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. **Required… more
- AdventHealth (Orlando, FL)
- …for our contracted managed care payers. The PA role is responsible for providing physician review of utilization , claims management, and quality assurance ... Collaborates with Senior Medical Officers with contracted managed care payers regarding utilization review management activities and maintain a positive and… more
- Atlantic Health System (Summit, NJ)
- …from ABQAURP (The American Board of Quality Assurance and Utilization Review Physicians), AAPL (American Association for Physician Leadership's Physician ... in Management course), or CPUR (Certification Program in Utilization Review ), Institute for Healthcare Improvement courses, or physician advisor training… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE ... see comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're… more
- The County of Los Angeles (Los Angeles, CA)
- …Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician member of the ... UTILIZATION REVIEW NURSE SUPERVISOR II Print...by subordinate supervisors on number and status of reviews, physician advisor referrals, and type of physician … more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... this position is able to cover a multitude of utilization review functions through point of entry,...process improvements). **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates with the physician and all members of the interprofessional health care… more
- Emory Healthcare/Emory University (Decatur, GA)
- …_,_ and leadership programs + And more **Description** We're seeking a **Clinical Utilization Review Nurse Preceptor (Registered Nurse / RN)** . This individual ... be responsible for training, mentoring, and coaching for the Utilization Review Department and must be an...+ Will play a vital role in partnering with Physician Advisors to ensure the Physician role… more
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