- Universal Health Services (Chicago, IL)
- …, External Independent Reviews, Retrospective Reviews, and State Fair Hearings. Review clinical information for all appeals utilizing nationally recognized ... of services requested. Prepare letters for member and provider appeals that did not meet criteria. Gather, analyze, and...and retrospective reviews through resolutions. Remain current on applicable UM trends and regulations and review current… more
- Universal Health Services (Doylestown, PA)
- Responsibilities Foundations Behavioral Health is currently hiring a full-time Utilization Review Coordinator to support our UM Department in Doylestown, PA. ... Disorders or other developmental disorders. Position Responsibilities: + The Utilization Review Coordinator provides support to the program and treatment… more
- Sharp HealthCare (San Diego, CA)
- …Reviews every patient under assigned workload initially and reviews based on review of care plan.Makes rounds and sees every patient identified per departmental ... guidelines during hospital stay beginning with the admission review of the case manager and reviews with the...to acute or visit to the Emergency Department.Informs Director, QI/ UM of any quality issues.Attends hospitalists rounds, as required,… more
- Corewell Health (Royal Oak, MI)
- …Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. Responsible for managing ... for patients utilizing hospital outpatient, observation or inpatient services. 4. May review cases for medical necessity, uses InterQual and/or other UR/ UM … more
- Universal Health Services (Bloomington, IN)
- Responsibilities The Utilization Management Specialist is responsible for executing the UM function, which includes the implementation of case management scenarios, ... Assures that good customer service practices are utilized. Maintains denials and appeals in Midas and reviews the progress of all appeal activity. Qualifications… more
- UCLA Health (Los Angeles, CA)
- …point of contact for receiving and resolving member denials. You will review denials for accuracy, confirming the receipt of necessary documentation to support ... federal laws/regulations. You will extrapolate and summarize essential information for the UM Manager and Medical Director and regularly meet with them for clinical… more
- St. Bernard's Medical Center (Jonesboro, AR)
- …the reimbursement and denial process. Works with infusion center to prevent denials. Assists UM Coordinator with denials and appeals . Close out each tracked ... and denials information according to discrete outpatient denial codes. Will review for medical necessity. Analyze information related to infusion denials and… more