- 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...$177,314.88 Annually Location Los Angeles County, CA Job Type Full time Job Number Y5126D Department HEALTH SERVICES Opening… 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 ... **Job Type:** Regular **Time Type:** Full time **Work Shift:** Day (United States of...billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review … 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
- 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)
- …you're not just taking a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management ... **Job Type:** Regular **Time Type:** Full time **Work Shift:** Day (United States of...causes of denials for discussion with the internal team, physician advisor and the Utilization Review… 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
- Dignity Health (Gilbert, AZ)
- …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... in the Phoenix area's East Valley. We offer a full breadth of care, from emergency and cardiovascular to...admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the… more
- Baptist Memorial (Jackson, MS)
- Overview Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and 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
- AmeriHealth Caritas (Dover, DE)
- …for approval or denial decisions. + Identify and escalate complex cases requiring physician review or additional intervention. + Ensure compliance with Medicaid ... efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… 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 ... want to make an impact. HonorHealth offers a diverse benefits portfolio for our full -time and part-time team members designed to help you and your family live your… more
- Bakersfield Behavioral Healthcare Hospital (Bakersfield, CA)
- …leadership, teamwork, and communication skills. ESSENTIAL DUTIES The primary responsibility of the Utilization Review Specialist is to review medical records ... of candidates. Education Associates Degree preferred Minimum Work Experience Utilization Review experience preferably in a behavioral/psychiatric healthcare… more
- Providence (Napa, CA)
- …Part time **Job Shift:** Day **Career Track:** Clinical Professional **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas St **Work ... (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico,… more
- AdventHealth (Altamonte Springs, FL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. 2) ... understanding that **together** we are even better. **Shift** : Full -time; Monday -Friday **Job Location** : Remote **The role...the UM nurse is responsible for escalation to the Physician Advisor or designated leader for additional review… more
- Intermountain Health (Murray, UT)
- …responsible for the development, implementation, evaluation, and operational management of utilization review programs to include prior authorization, acute and ... seamless experience for our members as they cross the full continuum of their healthcare journey. + Oversees program...+ Oversees program components related to care management and utilization review for the specific line of… more
- Penn Medicine (Princeton, NJ)
- …shape our future each day. Are you living your life's work? **Schedule:** Full Time **Summary:** + Conducts Utilization Management reviews for Princeton House ... Documents in the facility-wide computer system the results of each review , conducted both internally and externally (with managed care organizations). Familiarity… more
- Mount Sinai Health System (New York, NY)
- …influence other services by focusing on patient processes. 9. Develops and implements Utilization Review (UR) based on internal data collection, data received ... the delivery of comprehensive front-line Case Management services, including utilization management, care facilitation and discharge planning. The Assistant Director… 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 Type: ... Full Time Requisition ID: 12118 Salary Range: $88,854.00 (Min.)...net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and… more
- Omaha Children's Hospital (Omaha, NE)
- …physician advisor. o Guides admitting physician in protocols for conducting physician to physician review with third-party payers. o Appropriately ... and Friday, day shift, no weekends or holidays At Children's, the region's only full -service pediatric healthcare center, our people make us the very best for kids.… more
- UNC Health Care (Hendersonville, NC)
- … reviews in accordance with federal regulations and the health system's Utilization Review Plan. Responsibilities: + Uses approved criteria and conducts ... the health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge review … more
Related Job Searches:
Full,
Physician,
Physician Review,
Review,
Utilization,
Utilization Review,
Utilization Review Physician