- Southeast Georgia Health System (Brunswick, GA)
- …to convey same to physicians/office staff. Assists the Manager with validating that utilization review processes are conducted as outlined in the Utilization ... and are the key to our culture of Service Excellence. As a Resource Management Coordinator, you will conduct medical record reviews of all denied inpatient and/or… more
- UCLA Health (Los Angeles, CA)
- …leader with: * Current CA LVN licensure required * Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, ... in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely...for appropriate care and setting while working closely with denial coordinators and other staff to ensure the accurate… more
- Prime Healthcare (Bloomington, IN)
- …coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for ... Document and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working… more
- Prime Healthcare (Bristol, PA)
- …coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for ... and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely with… more
- UCLA Health (Los Angeles, CA)
- …point of contact for receiving and resolving member denials. You will review denials for accuracy, confirming the receipt of necessary documentation to support ... the denial and ensuring compliance with all contractual obligations and state and federal laws/regulations. You will extrapolate and summarize essential information… more
- HCA Healthcare (Charleston, SC)
- … Denial /Appeal management experience required Strong knowledge of utilization review , Interqual and/or medical necessity, federal plan administration, NCs ... leadership in developing and executing strategic initiatives related to denial management and root cause analysis and...growth, we encourage you to apply for our Division Denial Prevention Manager opening. We promptly review … more
- Sutter Health (Berkeley, CA)
- …for the appeal/ denial process, tracks and trends data, and coordinates utilization management activities for the assigned area. Collaborates with hospital ... and others to ensure appropriate utilization and quality care through utilization review , tracking and evaluation and objectively compare criteria with… more
- Billings Clinic (Billings, MT)
- …starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN CARE ... be eligible for tuition loan reimbursement Under the direction of department leadership, the Utilization Review / Management RN. This position is to conduct… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …educational training for medical staff on issues related to utilization management . 1. Implements utilization review policies and procedures. 2. ... mentoring, training and development. Educates and trains staff on utilization review processes and guidelines. 3. Promotes...clinical degree. + Minimum 3 years of clinical case management ( Utilization Management , Denial… more
- Catholic Health Initiatives (Omaha, NE)
- **Overview** Utilization Review RN is responsible for the review of medical records for appropriate admission status and continued hospitalization. Works in ... 1. Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted… more
- Glens Falls Hospital (Glens Falls, NY)
- …providing timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on ... foundhere. **Job:** **Nursing - Case Management * **Title:** *Registered Nurse - Utilization Review Nurse - Care Management (Sign-On Bonus for Full-Time &… more
- Actalent (San Bernardino, CA)
- Description: As a part of the Utilization Management team the Utilization Review RN is a member of the Care Coordination team. The goal of care ... relates to length of stay, covered bed days, issuing denial notices, working with Livanta, issuing DENCs and NOMNCs....to within scope of practice to Discharge assistant. Skills: Utilization review , prior authorization, Care management… more
- Universal Health Services (Doylestown, PA)
- Responsibilities Foundations Behavioral Health is currently hiring a full-time Utilization Review Coordinator to support our UM Department in Doylestown, PA. ... a Monday-Friday full-time position offering full-time benefits and competitive pay. The Utilization Management Coordinator is responsible for all utilization … more
- Prime Healthcare (Ontario, CA)
- …training in support of corporate revenue cycle initiatives to streamline utilization review (UR) and the denial management (DM) processes. This position ... education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/158530/ utilization - review -training-supervisor/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management… more
- Dartmouth Health (Lebanon, NH)
- Overview 40 hours per week - Fully Remote Position The Utilization Review RN facilitates transitions of care and bed availability through review of patient ... A comprehensive training program is available, howeverknowledge of UR and Care Management is preferred. Works with physicians and multidisciplinary team members to… more
- Milford Regional Medical Center (Milford, MA)
- …Statement of Purpose: The Utilization Review Nurse is responsible for utilization management at MRMC. The UR nurse performs reviews of current inpatient ... In addition, the UR Nurse will also manage the denial and appeal process under the guidance of the...Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- Trinity Health (Albany, NY)
- …position directly impacts process, flow, billing, ensuring correct status for patients, denial management , appeal rights/appeals and utilization ... **Employment Type:** Full time **Shift:** Day Shift **Description:** **Title:** Nurse Senior_ Utilization Management Lead **Shift** : M-F 8hr days/Hybrid (2 days… 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 ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and approve… more
- Universal Health Services (Chicago, IL)
- …for patient acuity and appropriate utilization . Completes quality and timely appeal/ denial letters. Participates in post claim recovery review and ongoing ... based on payer's criteria and in accordance with the hospital wide Utilization Management Plan. Serves as liaison to 3rd and 4th party reviewers, effectively… more
