- Intermountain Health (Las Vegas, NV)
- …health plan criteria, MCG criteria, and state, local, or federal guidelines relating to utilization management . + Demonstrated knowledge of case management , ... **Job Description:** This position interacts with UM physician and operational leadership. As the UM ...work experience related to inpatient management , case management , utilization management , quality … more
- Trinity Health (Darby, PA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The Appeals and Utilization Management Coordinator under direction and in collaboration with ... the RN Care Coordination Manager, provides support to the utilization management , denials and appeals process for...and processing the review to be conducted by the Physician Advisor to ensure all deadlines are met +… more
- Trinity Health (Boise, ID)
- …of two years' experience in hospital based medicine with exposure to utilization management and documentation initiatives. 3. Demonstrated teamwork, performance ... the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is the lead provider for coordination and… more
- Kepro (Indianapolis, IN)
- …partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job ... innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra...Summary: Our Utilization Management Appeals Nurse - LPN/RN will… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention ... potentially avoidable days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical and financial requirements and… more
- Kepro (Charleston, WV)
- …solutions in the public sector. Job Summary: Acentra Health is seeking RN Utilization management reviewerr statewide in West Virginia for an exciting ... innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra...opportunity. As an RN Utilization Management Reviewer, you will be actively… more
- Dignity Health (Bakersfield, CA)
- …Summary:** The Utilization Review LVN uses clinical judgement in providing utilization management services. The focus is to provide high quality ... Qualifications:** - Minimum 3-5 years of healthcare experience with general knowledge of Utilization Management and Managed Care. - Graduate of accredited school… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Lead Nurse Practitioner/ Physician Assistant (NP/PA) position is responsible for functioning as a clinical leader and scholar at the ... as a preceptor by mentoring others regarding care of defined populations in resource utilization and time management . + Provides clinical guidance as a Nurse… more
- Trinity Health (Livonia, MI)
- …cases that are appropriate and communicating to Insurance Verification and Health Information Management . * Functions as a resource to physician , hospital staff ... / MCG criteria to determine appropriate level of care. * Follows the hospital Utilization Review Plan to ensure effective and efficient use of hospital services. *… more
- Dignity Health (Bakersfield, CA)
- …Office applications; Excel, Word, Outlook. **Preferred Qualifications:** - Utilization management (UM)/prior authorization experience strongly preferred. ... Organization (Dignity Health MSO) is to build a system-wide integrated physician -centric full-service management service organization structure. We offer a… more
- Catholic Health Services (Melville, NY)
- …and management ; contributes to completion of project status reports. Lead meetings with staff and/or leadership to assist in establishing project priorities ... a home health service, hospice and a network of physician practices across the island. At Catholic Health, our...and managing resources) and all phases of the project management life cycle for a variety of initiatives Actively… more
- Kepro (Los Angeles, CA)
- …expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an ... a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team. Job Summary As a Utilization… more
- University of Washington (Seattle, WA)
- …. ** LEAD APP, GENERAL SURGERY & HOSPITAL MEDICINE ( LEAD NURSE PRACTITIONER OR PHYSICIAN ASSISTANT)** The Lead ... ARNP or PA-C) will, in collaboration with an attending physician , examine, diagnose and treat acute health problems. Responsibilities...and managing minor trauma and acute health problems. The Lead APP also leads and mentors other APPs in… more
- Stanford Health Care (Palo Alto, CA)
- …one of the Nation's most prestigious Cardiothoracic Surgery teams as an APP Leader. You will lead a team of APPs as well as have your own OR and Clinic time. We ... mission one patient at a time. **A Brief Overview** Provides supervision and management of advanced practice providers (APPs) in a distinct clinical service line.… more
- Kepro (Los Angeles, CA)
- …expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an ... for health solutions in the public sector. Position Overview: As a Utilization Reviewer, you involves reviewing medical records against appropriate criteria and… more
- Tufts Medicine (Burlington, MA)
- …on quality, ethical, regulatory, and/or financial topics related to patient care, utilization management /review, case management , and revenue cycle ... provider documentation queries. 12.Works with leaders to monitor appropriate utilization management and clinical documentation improvement performance and… more
- Hackensack Meridian Health (Holmdel, NJ)
- …package. + Engage in the teaching, consulting and advising of the care management and utilization review departments and hospital leadership. + Collaborate with ... patients while ensuring quality care is provided. + Develop expertise on physician practice patterns, over and under- utilization of resources, medical necessity,… more
- Mohawk Valley Health System (Utica, NY)
- …range of medical/clinical knowledge. + Expertise in, or willing to learn utilization management , state/federal regulations, private payer contracts. + Dedication ... PHYSICIAN ADVISOR Department: CASE MANAGEMENT Job...PREFERRED: + Certification preferred or eligibility for certification in utilization management via certifying boards within 1-2… more
- HCA Healthcare (Davie, FL)
- …flow, patient satisfaction, practice volume, billing and collections, service utilization , coding, physician and staff training. **Operational Effectiveness ... manages relationships with all physicians in the market/portfolio, HCA Physician Services management and support teams to...experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and… more
- UCLA Fielding School of Public Health (Los Angeles, CA)
- Faculty Transfusion Medicine and Patient Blood Management Physician Apply now to Faculty Transfusion Medicine and Patient Blood Management Physician Job ... overview Position title: Faculty Transfusion Medicine and Patient Blood Management Physician Salary range: The posted UC...transfusion medicine, and with the skills and interest to lead and grow a robust patient blood management… more