- Trinity Health (Stafford Springs, CT)
- …time **Shift:** Day Shift **Description:** RN or Social Worker **Position Purpose** The Utilization Management Specialist is responsible for acute care ... Management (Medical Records) and Admitting, to provide pertinent data relating to utilization management / clinical resource management issues and… more
- HonorHealth (Scottsdale, AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of ... of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary services. Responsible for coordinating and conducting medical… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...quality of care/potential fraud issues are identified and documented per LA Care policy. High risk/high cost cases and… more
- Great River Health (West Burlington, IA)
- …responsible for maintaining compliance with the CMS Conditions of Participation for Utilization Management .What you will do + Review inpatient encounters for ... Minimum Hiring Wage: From $39.37 per hour Job Details: Scheduled Hours: Day shift,...all state and Federal regulations for all UM reviews.-Practice utilization management activities within the scope of… more
- 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
- Cleveland Clinic (Cleveland, OH)
- …career with one of the most respected healthcare organizations in the world. As a Utilization Management Specialist , you will perform UM activities, such as ... a minimum of 85% on IRR quarterly. + Complete Utilization Management for assigned patients with a...for assigned patients with a minimum of 25-30 reviews per day. + Apply medical necessity guidelines accurately to… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
- Nuvance Health (Danbury, CT)
- *Description* Summary: Required- Registered Nurse ( RN) The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary team, ... and providing timely and accurate clinical information to payors. Utilization management provides clinically based first level...by the attending, and case does not meet criteria per first level medical necessity review, discuss case with… more
- Katmai (Fort Carson, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... background checks. **DESIRED QUALIFICATIONS & SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in Healthcare… more
- Ascension Health (Baltimore, MD)
- **Details** + **Department:** Utilization Management + **Schedule:** Hybrid work schedule available. Monday-Friday, 8:00AM-4:30PM. + **Hospital:** Ascension St. ... at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient...assists with the budgeting process. + Serve as content specialist for staff in the areas of utilization… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical ... SENSORY REQUIREMENTS: Requires sitting for up to 4 hours per day, 2 hours at a time. Standing for...+ Prefer minimum of 2-5 years' experience in case management and/or utilization management . +… more
- Hartford HealthCare (Willimantic, CT)
- …this is *your moment*. **Job:** **Other* **Organization:** **Rushford* **Title:** *Recovery Support Specialist (RSS) - The Ridge Recovery Center ( Per Diem)* ... to provide support to patients based on personal experience, a Recovery Support Specialist performs many different tasks. The Recovery Support Specialist first… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Utilization Management Specialist , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: ... to be named a Forbes "Best Employer" seven times. Position Summary: The Utilization Management Specialist I will perform utilization management … more
- Scripps Health (San Diego, CA)
- …ambulatory area **Job:** **Pharmacy* **Organization:** **Scripps Mercy San Diego* **Title:** *Pharmacist Specialist - Ambulatory Care - Per Diem - Float* ... *This is a non-benefited, per diem/casual position, with day shifts Monday through...and gastroenterology. *Why join this team?* The Clinical Pharmacist Specialist will support our various Ambulatory Services, including Medication… more
- New York State Civil Service (Albany, NY)
- NY HELP Yes Agency Education Department, State Title Contract Management Specialist 1, Contract Management Specialist Trainee 1, (NY HELPS) Box ... Class Competitive Class Travel Percentage 0% Workweek Mon-Fri Hours Per Week 37.5 Workday From 9 AM To 5...State Education Department is seeking candidates for a Contract Management Specialist 1 position in the Contract… more
- Trinity Health (Troy, NY)
- …that result from the clinical utilization reviews with the facilities Per Diem- Insurance Specialist to assist with authorizations for Substance abuse ... Specialist under general supervision, supports the administrative requirements for Utilization Management and works collaboratively with Utilization … more
- Federal Emergency Management Agency (Chicago, IL)
- …process improvements and present findings to leadership. Responsibilities In this Emergency Management Specialist position, you will serve as an Emergency ... Management Specialist in the Region 5, Mission Support Division. Typical...Fulfilling Regional staffing point of contact roles through the utilization of the FEMA Qualification System (FQS) and the… more
- AON (Charlotte, NC)
- …and Office Leaders How this opportunity is different: + Collaborate with Account Specialist staff, Account Management team, and Client Service Delivery Leaders ... initiatives to ensure efficiency and build standard processes. + Educate assigned Account Specialist by leveraging training plans in client management , risk … more
- AON (New York, NY)
- …Executive leaders How this opportunity is different: + Collaborate with Account Specialist staff, Account Management team, and Client Service Delivery Leaders ... initiatives to ensure efficiency and build standard processes. + Educate assigned Account Specialist by leveraging training plans in client management , risk … more
- Sharp HealthCare (San Diego, CA)
- …of the functions of Managed Care including HMO/PPO and ACO eligibility, claims, utilization management and the financial impact of decisions related to each. ... **Facility:** Corporate Offices **City** San Diego **Department** **Job Status** Per Diem **Shift** Day **FTE** 0 **Shift Start Time** **Shift End Time** Certified… more