- Merck & Co. (Rahway, NJ)
- … supply chain deliverables and prepares, analyses, and/or develops mitigation strategies for review with clinical partners and senior leaders. Works directly in ... Job DescriptionThe Global Clinical Supply (GCS) organization is accountable for managing...System-development and User Acceptance Testing (UAT) for assigned studies. Utilization of key technological tools and systems for GCS… more
- Metrowest Medical Center (Natick, MA)
- …patients. Identifies aftercare options for individual patients in conjunction with utilization review . Initiates appropriate contacts and follows up with ... of the Market Director of Behavioral Medicine, the Manager, Social Work and Clinical Services oversees all day to day social work operations for the behavioral… more
- Commonwealth Care Alliance (Boston, MA)
- …daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized clinical review and ... reports to the Director of Utilization Management - Oversees clinical decision review for services requiring prior authorization in a variety of clinical… more
- COOLSOFT (Raleigh, NC)
- …Business team for Clinical policies and Prior Authorizations, Drug Utilization Review (DUR) and pharmacy lock-in related processes, Behavioral health, ... Excellent Communication Skills HIPPA Specialist (Jobs in Raleigh, NC) Requirement id 155692... Clinical policies and Prior Authorizations. o Drug Utilization Review (DUR) and pharmacy lock-in related… more
- WORKCARE INC (Albany, OR)
- …injuries and illnesses. Services the IIPS provides include prevention, clinical diagnosis, therapeutic intervention, and rehabilitation of injuries and medical ... practice and as supported by the CMD or Medical Review Officer (MRO). Assists the CMD with health care...protocols and policies. Collaborates with the CMD to support clinical issues and client requests. Contributes insight to incident… more
- Stony Brook University (Stony Brook, NY)
- …line. **Job Number:** 2503477 **Official Job Title:** : TH Instructional Support Specialist **Job Field** : Professional Clinical **Primary Location** : ... Behavioral Health Specialist - Part Time **Position Summary** At Stony Brook...interventions, restraint/seclusion, behavior plan development and safety plan development, utilization and monitoring. + Conducts a variety of patient… more
- Stanford Health Care (Palo Alto, CA)
- …are used, all while maintaining or improving patient care quality. The specialist collaborates with physicians, clinical staff, and administrative leaders to ... Hour (United States of America) In the VBM Senior Specialist role, we are looking for a candidate who...to facilitate discussions effectively and bridge the gap between clinical , supply chain, and operational teams. Additionally, expertise in… more
- Conifer Revenue Cycle Solutions (Frisco, TX)
- JOB SUMMARY Manages activities of the Clinical Documentation Improvement department locally and/or across other Conifer's CDI departments. Lead the monitoring of ... in the planning, development and implementation, and ongoing success of the Clinical Documentation Management Program. Educates members of the patient care team… more
- Commonwealth Care Alliance (Springfield, MA)
- …centric individualized plan of care. The SBHC uses evidence-based care approaches, clinical skills, education, and training to influence the clinical outcomes ... of assigned patients by impacting acute care utilization , ensuring optimal treatment for behavioral health needs, and...various locations. This position reports to the CIC BH Clinical Manager. **Supervision Exercised:** + No, this position does… more
- Commonwealth Care Alliance (Springfield, MA)
- …to influence the outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment and closing gaps in care through connecting patients ... services. The CHW will play an integral role supporting patients with frequent utilization of Emergency Departments and acute admissions with the goal of identifying… more
- Commonwealth Care Alliance (Boston, MA)
- …needs, goals, and preferences. The Community Health Worker is knowledgeable of clinical care, health systems, and social drivers of health, and ensures that ... skills to improve CCA enrollee outcomes by impacting care access and utilization , closing care quality gaps, and optimizing member connection to medical, behavioral… more
- Katmai (Fort Carson, CO)
- …all levels of health care management to include outside agencies. Performs utilization management activities to optimize cost, quality, and access to care. Adhere ... operating instructions (operating instructions provided during orientation). Facilitate evidenced-based clinical practice. Provide comprehensive professional nursing care to normal… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... discounts and more Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review RN **Location** Tampa:St Josephs | Clinical | PRN **Req… more
- Montrose Memorial Hospital (Montrose, CO)
- …provided. This position combines the unique skill sets of the Utilization Review Nurse and Clinical Documentation Specialist to facilitate documentation ... patient. About The Career: + The purpose of the Clinical Revenue Specialist position is to ensure...experience preferred; and one (1) to two (2) years Utilization Review experience preferred. What We Offer:… more
- CaroMont Health (Gastonia, NC)
- …RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal ... NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case...Case Management preferred. Minimum of three years experience in clinical area with clinical review … 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...and advocating for appropriate levels of care. The UR Specialist works closely with clinical staff, admissions,… more
- Devereux Advanced Behavioral Health (Malvern, PA)
- …answered YES, then consider joining our Devereux Advanced Behavioral Health team! Being a Utilization Review Specialist at Devereux has its Advantages! You ... Children Behavioral Health Center (DCBHC) is currently seeking a Utilization Review Specialist to work...inpatient level of care youth. + Works closely with Clinical and Admissions teams regarding the MCO and insurance… more
- Westborough Behavioral Healthcare Hospital (Westborough, MA)
- …for a UR Specialist to provide Per Diem coverage. Job Description: The Utilization Review Specialist is responsible for monitoring adherence to the ... hospital's utilization review plan to ensure the effective...with government agencies including HIPAA requirements. + Submits discharge clinical as required by payers. + Upholds the Organization's… more
- Medical Center Hospital (Odessa, TX)
- + Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician...Licensed Vocational Nurse. B. Training and Experience: Three years clinical nursing experience in general medical/surgical setting or appropriate… more
