- Trinity Health (Darby, PA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The Appeals and Utilization Management Coordinator under direction and in collaboration ... process for the THMA South hospitals. The Appeals and Utilization Management Coordinator ensures the...workflow processes to ensure alignment with concurrent and retrospective denial management + Collaborates with health care… more
- Hackensack Meridian Health (Brick, NJ)
- …and serve as a leader of positive change. The **Care Management , Care Coordinator ** , ** Utilization Management ** is a member of the healthcare team ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Neptune, NJ)
- …and serve as a leader of positive change. The **Care Management , Care Coordinator , Utilization Management ** is a member of the healthcare team and ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Hackensack, NJ)
- …and serve as a leader of positive change. The **Case Management Care Coordinator , Utilization Management ** is a member of the healthcare team and ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Edison, NJ)
- …healthcare and serve as a leader of positive change. The Case Management Care Coordinator , Utilization Management is a member of the healthcare team and ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Edison, NJ)
- **Overview** The Care Management , Care Coordinator , Utilization Management is a member of the healthcare team and is responsible for coordinating, ... of the patient?s treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- YesCare Corp (Bartow, FL)
- …Veterans._ **Responsibilities** Below is a list of your responsibilities as a ** Utilization Management Coordinator ** with YesCare: + Confirms admissions ... with outside hospitals and notifies the Utilization Management Department of need to report...outside services + Assists in data entry + Communicates denial of inpatient charge to providers + Assists in… more
- Universal Health Services (Doylestown, PA)
- …is a Monday-Friday full-time position offering full-time benefits and competitive pay. The Utilization Management Coordinator is responsible for all ... of medical necessity and timely discharge planning. + Maintains data on utilization management activities and generates required reports, logs, and files… more
- Universal Health Services (Chicago, IL)
- …continued treatment based on payer's criteria and in accordance with the hospital wide Utilization Management Plan. Serves as liaison to 3rd and 4th party ... physician reviews with payers as required. Maintains all records/data pertaining to the Utilization Management Program. Actively participates in Utilization … more
- Universal Health Services (Chicago, IL)
- …Responsible for all denial and appeal activities for the Utilization Management department, including Expedited Appeals, Standard Appeals, External ... to resolve issues related to appeals. Maintains all records/data pertaining to the Utilization Management Program. Actively participates in Utilization … more
- State of Indiana (Indianapolis, IN)
- …Nurse (RN) in the State of Indiana. * Two years prior experience with utilization management . * Demonstrated competence in quality assurance and case ... Utilization Review Coordinator Date Posted: May...hospital stay. Oversees the issuance of Medicare A admission, denial notices and discharge appeal rights. Submits insurance verification/pre-certification… more
- Trinity Health (Livonia, MI)
- …/ MCG criteria to determine appropriate level of care. * Follows the hospital Utilization Review Plan to ensure effective and efficient use of hospital services. * ... guidelines for admission or continued stay. * In the event of an inpatient denial by the payer, obtains further documentation from the physician to support an IP… more
- Tenet Healthcare (Detroit, MI)
- …for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention Coordinating with ... potentially avoidable days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical and financial requirements and… more
- Baptist Memorial (Memphis, TN)
- …using evidence based criteria. Areas of work include payer notification, authorization management , denial management , escalations, and communication and ... Summary The Authorization Coordinator is responsible for facilitating information documentation and transmission vital to the effectiveness of utilization review… more
- Baptist Memorial (Memphis, TN)
- … management , medical necessity reviews, verification of authorization, resource utilization , and denial prevention. Responsibilities + Completes and enters ... Summary The Utilization Review Nurse is responsible for evaluating the...in the electronic medical record + Communicates with authorization coordinator + Communicates in-house high dollar case information Completes… more
- Rush University Medical Center (Chicago, IL)
- …managers, community providers, payers and internal/external agencies to provide case management support services related to effective utilization of services ... 1** **Work Schedule:** 8 Hr **Summary:** The Clinical resource coordinator (CRC) applies a collaborative approach in working with...denial appeals, and / or level of care management processes. * In accordance with the case … more
- Hartford HealthCare (Southington, CT)
- …of Connecticut's most comprehensive healthcare network as a Quality Improvement Coordinator . Hartford HealthCare at Home, the largest provider of homecare services ... corrected billing and chart reviews. **Document patient accounting system with all denial activity and actions taken. **Compile monthly denial reports.… more
- Baystate Health (Springfield, MA)
- …pediatric specialties. Prevents denials by identifying and documenting payor requirements for utilization management by employing a variety of methods including ... **Summary:** The Referral Authorization Coordinator is responsible for providing a variety of...payment for services provided. **4)** Consistently monitors and works denial and no referral reports to obtain prior authorizations… more
- Methodist Health System (Dallas, TX)
- … Management topics * Identifies opportunities for improved performance to Medical Management staff regarding denial management * Leads orientation of ... manner * Identifies barriers to achievement of departmental goals related to denial management and appropriately reports those suggestions for improvement… more
- Houston Methodist (Houston, TX)
- …complex patients, receiving coaching from experienced Transplant Coordinators and management , benefiting from their practice. The Pre-Transplant Coordinator ... At Houston Methodist, the Pre-Transplant Coordinator position a registered nurse, responsible for participating in department initiatives, facilitating, and… more