- The University of Vermont Health Network (Plattsburgh, NY)
- …Department at Champlain Valley Physicians Hospital (CVPH) in Plattsburgh, NY.GENERAL SUMMARY:The Utilization Review RN monitors, collects and analyzes data and ... evaluates variances of resource utilization , complications and overall quality of care ... based on benchmarked criteria or established practices. The Utilization Review RN in utilizing these skills… more
- Medical Solutions (Glendale, CA)
- Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Glendale, California.Job Description & ... tax-free stipend amount to be determined. Posted job title: Case Management ( Utilization Review )About Medical SolutionsAt Medical Solutions, we're people who … more
- South Shore Health (Weymouth, MA)
- …Looks for opportunities to reduce cost while assuring the highest quality of care is maintained. Applies review criteria to determine medical necessity for ... quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care...cases to appropriate manager or physician advisor for secondary review . c - Contacts attending physicians daily on cases… more
- RestoraCare Staffing (Houston, TX)
- …nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting. Completes Utilization Management and Quality ... Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department.Ensures that all elements critical to the… more
- South Shore Health (Weymouth, MA)
- …accurate, up-to-date and in compliance with format and content established by Clinical & Laboratory Standards Institute (formerly NCCLS), CAP and other regulatory ... agencies. Review and updates at least annually and maintains documentation...Responsible for the fiscal management of section; assures proper utilization of organization's financial resources.a. Establishes and submits section… more
- Sutter Health (Alameda, CA)
- …to meet the needs of the patients and to contribute to Quality Management review and evaluation.Must have the clinical knowledge and critical thinking ability to ... Sutter Health is seeking a Patient Care Tech Director for a job in Alameda,...and assists in meeting financial targets by effectively managing utilization , productivity, personnel and supplies. Participates as necessary in… more
- Beth Israel Lahey Health Behavioral Services (Danvers, MA)
- …Director; application of Quality Assurance and Customer Service Programs, implementation of Utilization Review mechanisms. 3. Assures sound fiscal management of ... major administrative functions of the treatment facility including: administration of clinical and medical documentation and record keeping systems; development of… more
- Adventist Health (Portland, OR)
- …monitoring the appropriateness and timeliness of care . Ensures the interdisciplinary care plan is consistent with the patient's clinical course, continuing ... acute care . Discusses with physicians, the appropriateness of resource utilization , consultations, treatment plan, estimated length of stay and discharge plan.… more
- Marion County (Salem, OR)
- …making data-driven decisions that support our department mission. A commitment to excellent clinical quality to the population we serve and ability to maintain high ... reducing barriers and treating the whole person.LeadershipProvide leadership to the Clinical Supervisors, and Program Supervisor and teams in YFS. Leadership… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …and promoting staff development.* Responsible for the utilization and continued review of patient care protocols, standards of practice, and standards of ... positive relationships with departments/programs, co-workers and external customers.* Provides care in various clinical settings with diverse person's… more
- South Shore Health (Weymouth, MA)
- …or: OFFERING NEW COMPETITIVE RATES AND A $7,500 SIGN ON BONUS! Provides respiratory care to patients as assigned by supervisors and given on the physician's order ... for both in-house and out-patient care .Job Description1 - Responsible for the safe and effective...order before treatment administered as evidenced by Process Improvement review . b - Discontinues treatment if any adverse or… more
- Highmark Health (Buffalo, NY)
- …**ESSENTIAL RESPONSIBILITIES** + Performs as the clinical subject matter expert for clinical , quality, care , utilization , high cost claim and population ... and accounts after customer discussions.Participate in ad-hoc and annual clinical review meetings as needed to provide...as quarterly and annual outcomes and trends for al clinical strategies for all current and emerging care… more
- Guthrie (Sayre, PA)
- …(UM) processes and requirements for prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures ... Position Summary: The Utilization Management (UM) Reviewer , in collaboration...eligibility for licensure required Experience: Minimum of five years clinical experience in an acute health care … more
- Kepro (Los Angeles, CA)
- …partner for health solutions in the public sector. Acentra seeks aUtilization Clinical Reviewer - LCSW/LMFT/LPCC/LCPC (Remote within California) to join our ... programs with experience navigating similar projects. + Ability to develop level-of- care recommendations based on clinical medical records and evaluations.… more
- University of Michigan (Ann Arbor, MI)
- Surgical Clinical Reviewer Apply Now **How to...the care continuum; according to definitions + Review of patient medical record to collect clinical ... meet the criteria for exempt status. **What You'll Do** The Pediatric Surgical Clinical Reviewer (SCR) is the primary individual responsible for the abstraction… more
- Prime Therapeutics (Columbus, OH)
- …fuels our passion and drives every decision we make. **Job Posting Title** Physician Clinical Reviewer - GI- REMOTE **Job Description Summary** Key member of the ... utilization management team, and provides timely medical ...clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting… more
- Kepro (IL)
- …to join our growing team. Job Summary: Our Behavioral Health Clinical Reviewer will coordinate program services and review activities associated with the ... Quality Improvement Organization (QIO) contract. The Child/Adolescent Behavioral Health Clinical Reviewer performs eligibility determination, residential treatment… more
- Evolent Health (Columbus, OH)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Physician Clinical Reviewer you will be a key member of the utilization ... when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the… more
- Centers Plan for Healthy Living (Margate, FL)
- …currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will...care managers and believe that coordinating high quality clinical and social services will result in better … more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, April 1, 2024 Centers Plan for Healthy Living's goal is to ... plans they need for healthy living. JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex medical necessity reviewed on Initial Adverse… more
