- CoxHealth (Lake Spring, MO)
- …Job Summary ◦ This position is responsible for facilitating timely and accurate physician documentation in the medical record through concurrent chart review . ... team regarding proper clinical documentation utilizing approved guidelines. Understand and utilization of ICD-10-CM and PCS coding assignment and follow Official… more
- Hackensack Meridian Health (Hackensack, NJ)
- The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical ... Hackensack University Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Penn Medicine (Philadelphia, PA)
- …Advisor role includes teaching, consulting, and advising case management, utilization review and provider staff. The physician advisor works with the. ... in attaining improved financial, quality, and patient flow measures by ensuring efficient and effective utilization of health care services. The Physician … more
- Sutter Health (Sacramento, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness ... health care services. The PA will develop expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical… more
- Beth Israel Lahey Health (Boston, MA)
- …a difference in people's lives.** Position Summary: In conjunction with the admitting/attending physician , the Utilization Review RN assists in determining ... the level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure… more
- CommonSpirit Health (Phoenix, AZ)
- …by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. + Physician Advisor Sub-specialty Certification ... This role will be an expert on matters regarding physician practice patterns, over and under- utilization of...by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. **Required… more
- Hackensack Meridian Health (Brick, NJ)
- …Engage in the teaching, consulting and advising of the care management and utilization review departments and hospital leadership. + Collaborate with a ... . + Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is **preferred** . + Physician… more
- AdventHealth (Orlando, FL)
- …for our contracted managed care payers. The PA role is responsible for providing physician review of utilization , claims management, and quality assurance ... Collaborates with Senior Medical Officers with contracted managed care payers regarding utilization review management activities and maintain a positive and… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE ... see comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're… more
- The County of Los Angeles (Los Angeles, CA)
- …Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician member of the ... UTILIZATION REVIEW NURSE SUPERVISOR II Print...by subordinate supervisors on number and status of reviews, physician advisor referrals, and type of physician … more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) responsible for promoting the achievement of ... an expert level at all objectives delineated in the Utilization Review Nurse and Utilization ...and data in a comprehensive manner. + Works with physician leadership and the interprofessional health care team for… more
- Emory Healthcare/Emory University (Decatur, GA)
- …_,_ and leadership programs + And more **Description** We're seeking a **Clinical Utilization Review Nurse Preceptor (Registered Nurse / RN)** . This individual ... be responsible for training, mentoring, and coaching for the Utilization Review Department and must be an...+ Will play a vital role in partnering with Physician Advisors to ensure the Physician role… 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
- Emory Healthcare/Emory University (Atlanta, GA)
- …attending physician and/or physician advisor. This individual will: + Perform utilization review by completing a timely and comprehensive review of ... + And more **Description** We're seeking an **Inpatient Registry Utilization Review Nurse (PRN)** who is responsible...documentation of authorized, unauthorized or denied days to the Physician and the care team in order to reduce… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 250924-5613FP-001 Location East Hartford, CT Date Opened 9/30/2025 12:00:00 AM Salary ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=)… more
- Trinity Health (Maywood, IL)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** Utilization Review - RN Reviewer- Regional Coverage for Loyola, Gottlieb and MacNeal ... Hospitals. Utilization Review - RN Reviewer- Regional Coverage for...are efficient and cost effective. + Collaborates with admitting physician regarding appropriate level of care/status determination. + Consults… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... of InterQual Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of CMS Regulations. **Working… more
- Dayton Children's Hospital (Dayton, OH)
- …concurrent and retrospective denials. The Physician Advisor role will support the Utilization Review RN for second level clinical reviews for cases that do ... Facility:Dayton Children's - Main CampusDepartment: Utilization Review TeamSchedule:Full timeHours:40Job Details:Under the supervision of the Manager of … more
- Beth Israel Lahey Health (Plymouth, MA)
- …and identifies trends/root causes of denials for discussion with the internal team, physician advisor and the Utilization Review Committee as appropriate. ... you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We Are:** At… more
- Dignity Health (Rancho Cordova, CA)
- …work from home within the Greater Sacramento, CA region.** **Position Summary:** The Utilization Review (UR) LVN uses clinical judgement in providing ... needed to reach determination. - Preps case thoroughly, concisely and clearly for physician review . Researches EMR, criteria, medical policy and past history of… more
