- 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
- Ochsner Health (New Orleans, LA)
- …Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (3) Physician Advisor Sub-Specialty Certification by ... at Ochsner Health and discover your future today!** The Physician Advisor (PA- Utilization Management) serves as the...the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (4) commitment… 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
- Sutter Health (Sacramento, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness ... health care services. The PA will develop expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical… more
- Beth Israel Lahey Health (Burlington, MA)
- …you're making a difference in people's lives.** In conjunction with the admitting/attending physician , the Utilization Review RN assists in determining the ... the level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure… more
- Billings Clinic (Billings, MT)
- …and coordinates care with the RN Care Manager, Social Services Care Manager, Utilization Review RN, Physician Advisor and Care Management Assistant. ... here. About Us Billings Clinic is a community-owned, not-for-profit, Physician -led health system based in Billings with more than...high risk for readmission. * Interfaces effectively with the Utilization Review department to stay current on… more
- Catholic Health Initiatives (Chattanooga, TN)
- …by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. + Physician Advisor Sub-specialty Certification ... the hospital through teaching, consulting, and advising the care management and utilization review departments, medical staff members, and the hospital… more
- Hackensack Meridian Health (Brick, NJ)
- …Engage in the teaching, consulting and advising of the care management and utilization review departments and hospital leadership. + Collaborate with a ... . + Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is **preferred** . + Physician… more
- Tenet Healthcare (Detroit, MI)
- Group Utilization Review Director - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves patients ... in Southeast Michigan. Summary Description SUMMARY: The Group Director, Utilization Review will perform the functions necessary...based on Medical Necessity and submits case for Secondary Physician review per Tenet policy Ensures timely… 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
- Emory Healthcare/Emory University (Duluth, GA)
- … physician and/or physician advisor. + The UR Specialist will perform utilization review by completing a timely and comprehensive review of all ... _development,_ and leadership programs + And more **Description** The Utilization Review (UR) Specialist is responsible for...documentation of authorized, unauthorized or denied days to the Physician and the care team in order to reduce… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- * Remote in Hampton Roads* Summary The Utilization Review Nurse combines clinical expertise with knowledge of medical appropriateness criteria, and applies ... and consultant to the multidisciplinary patient care team. The Utilization Review Nurse is responsible for ...+ Communicates following the chain of command regarding proper utilization of resources, physician concerns, length of… more
- Trinity Health (Des Moines, IA)
- …(IA), MercyOne Des Moines Join the MercyOne Family! We are looking to hire a Utilization Review RN! Responsible for the review of inpatient and outpatient ... the Case Management staff utilizing admission criteria guidelines-and second level physician review process when appropriate. Interacts with insurance providers… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Services As Needed / Per ... Req #:42005-31128 + FTE:0.01 + Posted:April 28, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible… more
- Intermountain Health (Las Vegas, NV)
- …1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims review , quality ... with MG clinicians, Affiliate Network PCPs and Specialists in the community, utilization management, care management, claims, network management, and finance. As the… more
- Dignity Health (Santa Cruz, CA)
- …+ _Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted ... for appropriate status determination._ + _Ensures compliance with principles of utilization review , hospital policies and external regulatory agencies, Peer… more
- Baptist Memorial (Meridian, MS)
- Overview RN Utilization Review Weekender Job Code: 22818 FLSA Status Job Family: NURSING Job Description Title: RN Utilization Review Weekender Job ... appropriateness of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works...necessity or other areas when indicated + Communicates with physician advisors related to status concerns or denials +… more
- Beth Israel Lahey Health (Plymouth, MA)
- …and identifies trends/root causes of denials for discussion with the internal team, physician advisor and the Utilization Review Committee as appropriate. ... you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We Are:** At… more
- Nuvance Health (Danbury, CT)
- …any issues/denials to department leadership.* * 12) Forwards reviews that require secondary physician review to appropriate resource ( Physician Advisor) 13) ... Required- Registered Nurse ( RN) The purpose of the Utilization Management Nurse is to support the physician...as required. Education: ASSOCIATE'S LVL DGRE Preferred- Two Years Utilization Review Experience Required- Registered Nurse (… more
- Houston Methodist (The Woodlands, TX)
- …improvements, patient satisfaction). **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates with the physician and all members of the interprofessional health care team to ... for the department and the hospital. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource use,… more
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