- Fort Duncan Regional Medical Center (Eagle Pass, TX)
- …and discharge rounds. Manage department budget, staffing, and training needs. Function as Utilization Review / Denials Manager as required. Qualifications ... review , and transitions to prevent readmissions. Liaise with medical staff, utilization review , social services, payors, and community providers. Track and… more
- Sheppard Pratt (Amesbury, MA)
- General Summary Under general supervision, provides day-to-day leadership of the utilization review process of patients admitted to the Hospital for Inpatient ... Trains or ensures the proper training of newly hired Utilization Review Coordinators, coordinates work assignments, and...of medical necessity and appropriateness of admission/continued stay, case review for appeals of payment denials , and… more
- Kaiser Permanente (Aurora, CO)
- …appropriately. Serves as Subject Matter Expert (SME) for Utilization Review workflow issues, complex cases, denials , and internal/external customers. Manages ... requests, including discharge planning activities when needed (collective referred to as Utilization Review ) for the Colorado region. Manages utilization … more
- AHS Vista LLC (Waukegan, IL)
- …the case management process. Coordinate the discharge planning process. Perform utilization review duties. Support PHIP. Maintain documentation. Provide ... information regarding denials and approvals. Provide education to patients, physicians, multidisciplinary team & the community. Requirements : Graduate of accredited… more
- AHMC Healthcare (San Gabriel, CA)
- …organizing, controlling, and directing all services and operations in the areas of Utilization Review and Discharge Planning. With primary focus of this role ... being on patient throughput, length of stay and denials . This position requires providing managerial/administrative supervision to departments which provide services… more
- NavitsPartners (Hyannis, MA)
- …and validate appropriately Identify and refer complex psychosocial or financial issues Utilization Review & Reimbursement: Conduct reviews to ensure efficient ... Job Title: Travel Case Manager - LPN/RN (Emergency Department) Location: Hyannis, MA...years) 2+ years in case management, discharge planning, and utilization review Familiarity with InterQual(R) or comparable… more
- Nuvance Health (Poughkeepsie, NY)
- …or BSN preferred. Must have current RN license. Preferred experience in Utilization Review /Management. Location: Vassar Brothers Medical Center Work Type: ... Summary: Under the general supervision of the Director, The Nurse Case Manager role provide clinically-based case management to support the delivery of effective… more
- Vizient, Inc. (Jefferson, PA)
- …projects/initiatives for health care organizations targeting contracting and clinical utilization opportunities as well as innovative strategies to reduce cost ... of the pharmacy revenue cycle, including charge capture and coding, reimbursement/ denials , and process improvement. Work with pharmacy distributor and pharmacy… more
- Franciscan Missionaries of Our Lady Health System (Lafayette, LA)
- …and analysis of annual financial goals of targeted population. Performs effective utilization review techniques to work with physicians, third party payors ... supporting a balance of optimal care and appropriate resource utilization . The Case Manager will identify potential...and continued stay. Meets with treatment team to provide utilization review information, discusses issues pertaining to… more
- Kaiser Permanente (Seattle, WA)
- …seamless admissions, transfers, and discharges to minimize diversions, delays, or denials of patients. Functions as on-site administrative representative in the ... (4) hours. Communicates at Huddles and directly with Charge Nurse to: Review current patients. Identify pending/potential discharges. Determine capacity for and time… more
- Beth Israel Lahey Health (Plymouth, MA)
- …you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding UR… more
- Beth Israel Lahey Health (Plymouth, MA)
- …is expanding its **Care Transitions Department** and seeking an experienced ** Manager of Utilization Review & Denials Management** and ** Utilization ... or other case management certification preferred or in progress ** Manager - Utilization Review & Denials Management** This role is ideal for a Manager… more
- Hartford HealthCare (Farmington, CT)
- …practices. *_Position Responsibilities:_* *Key Areas of Responsibility* *Denial Resolution* . Review DRG validation denials from payers, analyze the denial ... The Denial Specialist 2 is responsible for reviewing, analyzing, and appealing denials related to DRG (Diagnostic Related Group) validation denials . This… more
- AdventHealth (Glendale Heights, IL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... and financial indicators including LOS, cost per case, avoidable days, resource utilization , readmission rates, concurrent denials , and appeals. *Uses data to… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... this position is able to cover a multitude of utilization review functions through point of entry,...plan of care and ensures prompt notification of any denials to the appropriate case manager , … more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- Dignity Health (Carmichael, CA)
- **Responsibilities** **Day Per Diem Utilization Review Registered Nurse - Onsite Campus Position** The ** Utilization Review RN** is responsible for the ... Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies + Collaborates with...admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the… more
- Children's Hospital Boston (Boston, MA)
- …Posting Title:Per Diem RN Case Manager , Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard ... denials . They identify and implement initiatives to manage utilization trends, collaborating with the hospital's discharge planning case managers, healthcare… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... plan of care and ensures prompt notification of any denials to the appropriate case manager , ...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
- UNC Health Care (Chapel Hill, NC)
- …care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management ... needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in… more
