- MedStar Health (Baltimore, MD)
- Candidates with previous Utilization Review or Denials /Appeals experience preferred General Summary of Position Responsible for coordinating and monitoring the ... timely patient care. Identifies process issues related to the concurrent Case Management system, including appropriate resource utilization and identification of… more
- UF Health (Gainesville, FL)
- …planning, design, implementation, and oversight of UF Health Shands CDI Program and Denials Management Program. The CDI program aims to improve the overall ... patient care in adherence to industry best practices. The Denials Management Program aims to analyze root...years of recent clinical experience in a hospital setting. Utilization Management , Case Management , Quality… more
- Children's Mercy KC (Kansas City, MO)
- …leadership, strategic planning, and oversight of daily operations of the case management department which includes utilization management , care progression ... Partners with Revenue Cycle, Payor Relations, HIM and Risk Management in support of utilization management...the work of Nurse Case Managers, Social Workers, and Utilization Review specialist team members and support… more
- Texas Health Resources (Arlington, TX)
- …heavily on a team atmosphere and individual performance. *Highly engaged management Texas Health Arlington Memorial Hospital, a 369-bed acute-care, full-service ... PCP and attempts to schedule follow up appointments with either a PCP, specialist , clinic, visiting physician or other transitional care visit prior to discharge.… more
- St. Luke's University Health Network (Allentown, PA)
- …communities we serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party ... JOB DUTIES AND RESPONSIBILITIES: + Reviews all Inpatient Retroactive Denials in the Denials Management ...+ Prefer minimum of 2-5 years' experience in case management and/or utilization management . +… more
- Hartford HealthCare (Farmington, CT)
- …**Job:** **Coding and Billing* **Organization:** **Hartford HealthCare Corp.* **Title:** * Denials Specialist 2 / HIM Coding* **Location:** ... now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
- Mount Sinai Health System (New York, NY)
- …Excel and Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt...EOW** To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring… more
- BriteLife Recovery (Englewood, NJ)
- …compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in denials , approvals, and length-of-stay ... What you will be doing? The Utilization Review (UR) Specialist is a...you? + Minimum of 2-3 years of experience in utilization review, case management , or insurance coordination… more
- Spectrum Billing Solutions (Skokie, IL)
- …cycle management company for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team. The Utilization Review ... and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for treatment… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of ... of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary services. Responsible for coordinating and conducting medical… more
- Nuvance Health (Danbury, CT)
- …(2nd week) ; rotate one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary team, and ... of care and providing timely and accurate clinical information to payors. Utilization management provides clinically based first level medical necessity reviews… more
- UnityPoint Health (Cedar Rapids, IA)
- …Adolescent Treatmt/Child S + Shift: 8 + Job ID: 168048 Overview The Utilization Management Specialist in the Behavioral Health Hospital Outpatient ... outcomes and patient and provider satisfaction. The RN UM Specialist provides the Utilization Management ...to include: clinical needs, barriers to quality care, effective utilization of resources and pursues denials of… more
- Catholic Health Initiatives (Omaha, NE)
- …2 hours of a Commonspirit Health Facility Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact patient ... our patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! As our … more
- Baptist Memorial (Memphis, TN)
- Overview Specialist -Denial Mitigation II RN Job Code: 21432 FLSA Status Job Family: FINANCE Job Summary * Position may be filled in Memphis, TN; Jackson , MS The ... Denial Mitigation-Appeal Specialist II RN serves in a key role of...along to healthcare insurance providers in response to post-claim denials received by BMHCC. Physician Advisor communication may be… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... **Job Summary** The Clinical Utilization Review Specialist is responsible for...extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key… more
- Trinity Health (Troy, NY)
- …of possible concurrent denials , forwards information to the appropriate Utilization Management /Concurrent Review Nurse within identified process standards * ... Specialist under general supervision, supports the administrative requirements for Utilization Management and works collaboratively with Utilization … more
- Dana-Farber Cancer Institute (Brookline, MA)
- …molecular pathology, high-cost drug, and off-label drug authorizations. The Clinical Authorization Specialist is also responsible for managing denials related to ... Experience:** + 1 year of clinical and/or related experience required. Case Management , Utilization Review and/or Prior Authorization experience is preferred. +… more
- Dana-Farber Cancer Institute (Brookline, MA)
- … Specialist is responsible for the comprehensive coordination and management of all prior authorization activities specific to cellular therapy services. ... preferred. + 1 year clinical and/or related experience required. + Case Management , Utilization Review, Oncology, Cellular Therapy and/or Prior Authorization… more
- Penn Medicine (Philadelphia, PA)
- …1500 Market Street Hours: M-F 8a-4:30p, Remote The Health Information Management (HIM) Clinical Documentation Specialist will oversee organization-wide system ... throughout the organization that requires coding and documentation knowledge. Assist Coding Management staff in performing quality audits on coding staff and assist… more
