- 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
- 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 ... 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
- 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 ... practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case Management preferred. Minimum… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… 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 Advisors. + Qualifications: A. Education: Holds a current Texas… more
- Hunterdon Health Care System (Flemington, NJ)
- This is an in-person role. Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure ... an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the… more
- AnMed Health (Anderson, SC)
- …necessity review , continued stay/concurrent review , retrospective review , bed status management, resource utilization management, regulatory compliance, ... assigned utilization management functions daily: initial, concurrent and retrospective review of the medical record with speed and accuracy for all required… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional Care Team.This is a full-time role and will be required to work ... this position: *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include… more
- State of Michigan (Lansing, MI)
- …To identify psychotropic medication regimens that require additional physician review according to policy, the Utilization Reviewer actively monitors ... to identify foster care individuals with psychotropic medication regimens that require additional physician review , preparing the physician review … more
- SUNY Upstate Medical University (Syracuse, NY)
- …including PC, Windows, Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, ... Job Summary: The UR-CR Specialist I is primarily responsible for ensuring that...reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria… more
- UPMC (Bridgeville, PA)
- UPMC Rx Partners is looking for a full time Pharmacy Clinical Review Specialist to join their dedicated team! You will oversee administrative and system ... that relate to pharmacy prior authorizations. Manage the first line clinical review of prior authorization requests for Community Provider Services and their… more
- Mohawk Valley Health System (Utica, NY)
- … regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of...and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides… more
- HCA Healthcare (Asheville, NC)
- …and personal growth, we encourage you to apply for our Provider Solutions Specialist opening. We promptly review all applications. Highly qualified candidates ... We care like family! Jump-start your career as a Provider Solutions Specialist today with Mission Hospital. **Benefits** Mission Hospital offers a total rewards… more
- HCA Healthcare (Gainesville, FL)
- …and personal growth, we encourage you to apply for our Provider Solutions Specialist opening. We promptly review all applications. Highly qualified candidates ... **Introduction** Do you have the career opportunities as a(an) Provider Solutions Specialist you want with your current employer? We have an exciting opportunity… more
- HCA Healthcare (Kansas City, MO)
- …facilitates access review audits. + Tracks, monitors, and enhances provider utilization of HCA technologies, by offering at the elbow support and one-on-one ... to join an organization that invests in you as a(an) Senior Provider Solutions Specialist ? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300… more
- HCA Healthcare (Dallas, TX)
- …staff performance evaluations. + Acts as manager in charge as assigned. + Provides review and guidance on physician order sets and other evidenced based ... in daily multidisciplinary and bedside rounds + Completes drug utilization reviews to promote rational drug therapy and implement...we encourage you to apply for our Clinical Pharmacist Specialist BMT opening. We promptly review all… more
- Sharp HealthCare (Chula Vista, CA)
- …be utilized for ongoing professional practice evaluation and re-credentialing.Collaborates with physician leadership to establish meaningful peer review criteria ... **What You Will Do** The purpose of the Sr. Performance Improvement Specialist is to improve clinical outcomes including responsibilities relating to leading teams… more
- HCA Healthcare (Portsmouth, NH)
- …of case review , data abstraction, management and reporting. The Sr. Specialist will actively provide support and carry out assigned functions within the Patient ... in support of improvement initiatives * Contributes to the physician performance improvement program including Peer Review ...encourage you to apply for our Sr Clinical Quality Specialist opening. Our team will promptly review … more
- HCA Healthcare (Dallas, TX)
- …acute inpatient rehabilitation services prior to returning home. The Clinical Rehabilitation Specialist will review these patients daily until they have strong ... clinical evidence to request a physician order for a formal pre-admission assessment for acute...we encourage you to apply for our Clinical Rehab Specialist opening. We promptly review all applications.… more
- Abbott (Plano, TX)
- …insurance, Worker's Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review . Some experience in medical device or DME ... currently has an opportunity for a **Patient Therapy Access Specialist ** (PTA). This is an in office 5 days...Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review . + Experience in medical device… more