- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team. The Utilization ... and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for treatment… more
- Baylor Scott & White Health (Dallas, TX)
- …Note: Benefits may vary based on position type and/or level **Job Summary** Utilization Review Specialist conducts reviews and shares knowledge with healthcare ... staff. Works closely with Medical Director and Health Services leadership. Manages utilization and formulates policies. The role is integral in navigating healthcare… more
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Utilization Review Specialist (Remote Option in Wisconsin) **Cost Center:** 101651289 ... **_Remote work available for Wisconsin residents only_** **JOB SUMMARY** The Utilization Review Specialist , Revenue Cycle Provide quality assurance of… 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 ... and Hackensack UMC. These include but are not limited to utilization review, hospital reimbursement, clinical compliance, case management, and transitions of… more
- Hunterdon Health Care System (Flemington, NJ)
- Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure the effective and efficient use of ... an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the… 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 stay.… more
- AdventHealth (Tampa, FL)
- …such as heart failure, cancer and other diseases. **The role youll contribute:** The Utilization Management (UM) Specialist works under the direction of the ... Utilization Management Manager and supports the Utilization Management team with Emergency, Observation and Inpatient visits. The UM Specialist is responsible… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible ... for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD) treatment at… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The 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
- 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: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Henry Ford Health System (Troy, MI)
- …of pharmacy services, decrease waste, and rework in the region, and improve drug utilization . The Pharmacy Specialist will be instrumental in guiding the further ... GENERAL SUMMARY:The Pharmacy Specialist provides oversight and leadership for appropriate drug...provided by the primary care team. He/she works with utilization management reports, corporate data stores, and information services… more
- Nuvance Health (Danbury, CT)
- …week) ; rotate one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary team, and ... of care and providing timely and accurate clinical information to payors. Utilization management provides clinically based first level medical necessity reviews by… more
- Sutter Health (Berkeley, CA)
- …to justify acute hospital admission, need for continued stay, and proper utilization of physician, nursing, and ancillary services. Responsible for concurrent review ... for the appeal/denial process, tracks and trends data, and coordinates utilization management activities for the assigned area. Collaborates with hospital… more
- Sanford Health (Fargo, ND)
- …added to wage ** **Department Details** This role will be supporting the Utilization Management team in various administrative tasks. We are seeking a candidate that ... has a great questioning attitude, strong organizational skills, ability to prioritize and adapt to changes. **Job Summary** Two major functions of the Patient Access Representative (PAR) are patient registration and scheduling. Depending on setting, the PAR… more
- Catholic Health Initiatives (Omaha, NE)
- …2 hours of a Commonspirit Health Facility Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact patient ... our patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! As our … more
- Amergis (Rancho Cordova, CA)
- … Management. Apply today to learn more about the current opportunities! The Utilization Review Specialist is responsible for theassessment and review of the ... + A Bachelor's Degree in Nursing or at least two years'experience in Utilization Review preferred + Certification in Utilization Review or UtilizationManagement… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Utilization Management Specialist , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: ... named a Forbes "Best Employer" seven times. Position Summary: The Utilization Management Specialist I will perform utilization management functions to… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… more
- Commonwealth Care Alliance (Boston, MA)
- …is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA)...Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the… more
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