- AmeriHealth Caritas (Philadelphia, PA)
- …www.amerihealthcaritas.com. **Responsibilities:** Under the direction of the unit Supervisor, the Clinical Care Reviewer- Shift Care is responsible for ... managing requests for pediatric shift care services including skilled nursing and home health aide...a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care… more
- Commonwealth Care Alliance (Boston, MA)
- …health managed care preferred + Experience in behavioral health utilization review or medical necessity evaluation preferred **Required Knowledge, Skills ... Mgmt **Position Summary:** The Sr Clinician, Behavioral Health Utilization Review will review behavioral...and legislative requirements. + Focus on effective and appropriate utilization of alternative levels of care and… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one… more
- Tenet Healthcare (Detroit, MI)
- Group Director Utilization Review - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves ... diverse employers in Southeast Michigan. Summary Description SUMMARY: The Group Director, Utilization Review will perform the functions necessary to support and… more
- Beth Israel Lahey Health (Burlington, MA)
- …Description:** The Inpatient Registered Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and ... team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg experience… more
- University of Utah Health (Salt Lake City, UT)
- …as a team member. **Qualifications** **Qualifications** **Required** + **One year** ** Utilization Review or Case Management experience.** **Licenses Required** + ... to monitor appropriateness of admissions with associated levels of care and continued stay review . + Communication...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Trinity Health (Des Moines, IA)
- …(IA), MercyOne Des Moines Join the MercyOne Family! We are looking to hire a Utilization Review RN! Responsible for the review of inpatient and outpatient ... **Employment Type:** Full time ** Shift :** Day Shift **Description:** At MercyOne, health care ...discharge. + Carries out hospital programs and principles of utilization review in compliance with hospital policies… more
- Beth Israel Lahey Health (Plymouth, MA)
- …to level of care determination and the appeal/denial process. + Oversees utilization review workflow processes to ensure timely response to denials. + ... **Job Type:** Regular **Time Type:** Full time **Work Shift :** Day (United States of America) **FLSA Status:**...a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager -… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... Department/Unit: Care Management/Social Work Work Shift : Day...Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal… more
- Stanford Health Care (Palo Alto, CA)
- …and Abilities** + Knowledge of principles and best practices of case management, utilization review , social work, care coordination and discharge planning. ... in case management - 3+ years of experience in utilization review Why work at Stanford Medicine...Utilization Management team. Are you driven by health care innovation, partnerships, and measurable results to improve the… more
- R1 RCM (Detroit, MI)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse** , you will help our hospital ... **Location:** Remote, US ** Shift :** Weekend Evening schedule **Fri/Sat/Sun/Mon 2 PM -...position. **Here's what you will experience working as a Utilization Review Nurse:** + Perform initial admission… more
- Centene Corporation (Little Rock, AR)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... the training period. After training, standard work hours will shift to 8:00 AM to 5:00 PM (CST and...healthcare teams to review care services related to mental health… more
- St Joseph's Addiction Treatment & Recovery Centers (Saranac Lake, NY)
- …Centers Location: Inpatient Facility - Saranac Lake, NY Position: Full-time Utilization Review Specialist Shift /schedule: Monday-Friday, 8:00am-4:30pm Pay ... directed by Supervisor, supporting the agency's mission and client care quality. Department Utilization Review ...agency's mission and client care quality. Department Utilization Review Employment Type Full-Time Minimum Experience… more
- Providence (Napa, CA)
- …**Job Shift :** Day **Career Track:** Clinical Professional **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas St **Work Location:** ... needs while enabling them to access and utilize medical care and community resources in order to achieve their...compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift … more
- Beth Israel Lahey Health (Plymouth, MA)
- **Job Type:** Regular **Time Type:** Part time **Work Shift :** Day (United States of America) **FLSA Status:** Non-Exempt **When you join the growing BILH team, ... + Reviews admission data to establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge… more
- Queen's Health System (Honolulu, HI)
- RESPONSIBILITIES I. JOB SUMMARY/RESPONSIBILITIES: * Coordinates and maintains the utilization review process for clinical services including medical, surgical ... Clinics (QEC). * Performs duties and responsibilities in accordance with utilization tracking and prior authorization procedures. * Assists with coordinating and… more
- Beth Israel Lahey Health (Burlington, MA)
- …Care , Physician Advisors Works collaboratively managing the process of Utilization Review throughout the system **As a health care organization, we have a ... collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities… more
- Beth Israel Lahey Health (Boston, MA)
- **Job Type:** Regular **Time Type:** Full time **Work Shift :** Day (United States of America) **FLSA Status:** Non-Exempt **When you join the growing BILH team, ... a difference in people's lives.** The Administrative Assistant II will support the Utilization Management team, and will work with the Data Analyst and the… more
- Covenant Health Inc. (Knoxville, TN)
- …meetings between physicians and payors as applicable. + Completes daily work lists for utilization review meeting the time frames set forth by Covenant Health. + ... Management Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is East Tennessee's...+ Promote appropriate admission status + Provide continuity of care between utilization management and care… more
- AdventHealth (Altamonte Springs, FL)
- …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. 2) ... All while understanding that **together** we are even better. ** Shift ** : Full-time; Monday -Friday **Job Location** : Remote...- greater than five years . Minimum four years Utilization Management within acute care setting .… more