- Trinity Health (Maywood, IL)
- …our small but mighty team to guide and manage Utilization Review and Management for the Loyola Physician Partners LPP) Health Plan, a delegated entity for ... preauthorization requests utilizing defined criteria. Collects, analyzes and communicates relevant utilization management information to insurers and third party… more
- Providence (Seattle, WA)
- **Description** **THE ROLE** The Senior Director Utilization Management & Denials - Administration is 100% remote. The role requires a broad knowledge and focus ... on Utilization Management and Denials principles such as...necessity criteria. The role requires the ability to consistently lead , support, and coach UM/UR staff and leaders. The… 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
- Dignity Health (Rancho Cordova, CA)
- …**Preferred Qualifications:** - 7 years UM experience with Charge/ Lead /Supervisory/ Management experience in Utilization Management department preferred. ... the guidance and supervision of the department Manager/Director, the Supervisor of Utilization Management is responsible and accountable for coordination of… 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
- Houston Methodist (Houston, TX)
- JOB SUMMARY At Houston Methodist, the Lead Nurse Practitioner/ Physician Assistant (NP/PA) position is responsible for functioning as a clinical leader and ... as a preceptor by mentoring others regarding care of defined populations in resource utilization and time management . (EF) 3. Provides clinical guidance as a… more
- Centerwell (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Physician Lead serves as a health-care professional and capable of handling a variety ... of health-related problems. The Physician Lead works on problems of diverse...of GA. + Consults with advance practice providers on management of complex patients. + Lead daily… more
- Elevance Health (Columbus, OH)
- …+ New Jersey, Morristown **Description** **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits ... Medical Director - Utilization Review** + Job Family: MED > Licensed Physician /Doctor/Dentist + Type: Full time + Date Posted:Apr 17, 2024 + Anticipated End… more
- Virtua Health (Pennsauken, NJ)
- …than 14,000 colleagues, including over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, ... records, and referrals.* Acts as a liaison with Patient Accounting and/or Physician billing services as required to clarify billing and charge issues.*Produces,… 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
- 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
- Sharp HealthCare (San Diego, CA)
- …time for routine, urgent and expedited referrals as outlined in SCMG's Utilization Management Plan.Decisions will be communicated to the appropriate persons ... + Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, established criteria such as… 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
- CommonSpirit Health Mountain Region (West Jordan, UT)
- …discretion, and independent judgment in assessing/reassessing, facilitating care coordination, utilization management , and patient advocacy. + Assure medical ... for Life Colorado TM , telehealth and over 240 physician practices and clinics offer endless opportunities! Here, you...the most diverse communities across the nation, letting humankindness lead the way. Overview: You have a purpose, unique… 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 ... service requirements. + Determine approval or initiate referrals to the physician consultant, processing decisions and providing detailed denials as needed. +… more
- HCA Healthcare (Kansas City, MO)
- …as patient flow, patient satisfaction, practice volume, billing and collections, service utilization , coding, physician and staff training** + **You will have ... operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers.… more
- HCA Healthcare (Fort Pierce, FL)
- …in 21 states and the United Kingdom. We are looking for a **Director of Physician Services II to lead Practice Operations** for our **Treasure Coast Market** , ... such as patient flow, patient satisfaction, practice volume, billing and collections, service utilization , coding, physician and staff training + You will have… more
- HCA Healthcare (Austin, TX)
- …such as patient flow, patient satisfaction, practice volume, billing and collections, service utilization , coding, physician and staff training + You will have ... operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers.… more
- AdventHealth (Highlands Ranch, CO)
- …(ERD), Medicare, Medicaid or other federal and state reimbursement plans. * **.** Physician will participate and lead in various activities and initiatives that ... at all times with Hospital's policies and procedures; financial reviews, utilization review/quality management , compliance and integrity program; compliance and… more