- WakeMed (Raleigh, NC)
- Overview The Behavioral Health Case Manager for Utilization Review is responsible for assisting patients and families in recognizing and managing mental health, ... denied by insurance companies. Assists in the implementation of the Hospital Utilization Review Plan. Provides consultation and/or education to clinical staff… more
- Caron Treatment Centers (Delray Beach, FL)
- …for family members and referrals; this includes efforts to solidify/confirm potential admissions , as well as provide the services throughout a treatment episode ... referrals, industry changes and census trends. Works with Corporate Director of Admissions , Regional Resource Directors team, and others to manage and effectively… more
- Behavioral Health (Sioux Falls, SD)
- …evening work may be required. Flexibility in scheduling. POSITION SUMMARY The Outpatient Admissions Specialist will have the responsibility of assisting with all ... outpatient behavioral health admissions and communications within programming. This also includes scheduling...insurance coverage. B. Ensure the completion of all required pre- admission and admission documents. C. Initiate positive,… more
- UHS (Palmdale, CA)
- …retrospective review of inpatient medical records to evaluate the utilization and documentation of acute care services.Responsible for improving the overall ... Healthcare is seeking a Full-Time Remote RN Clinical Documentation Integrity Specialist . Duties include but not limited to: Providing clinically based concurrent… more
- Conifer Health Solutions (Federal Way, WA)
- …DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Record Review : Completes initial medical records reviews of patient records within 24-48 ... hours of admission for a specified patient population to: (a) evaluate...mortality and severity of illness; and (b) initiate a review worksheet. Conducts follow-up reviews of patients every 2-3… more
- Los Angeles Metro (Los Angeles, CA)
- …transportation when needed to carry out job-related essential functions Licensed Attorney Admission to California Bar, maintaining status as active and in good ... in (defined as the proficient manual, verbal, or mental utilization of data, people, or things) Performing legal research...a resume or other documentation as we will not review resumes to determine qualifications. The information provided in… more
- Tenet Healthcare Corporation (Detroit, MI)
- …resolve conflict. Promotes a positive customer relations environment. Coordinates the utilization review function for assigned patients. Performs periodic ... and timely manner, at the most appropriate level of care. Performs continuous review of services to assure patient progress and maintains communication with families… more
- CAMC Health System (Weston, WV)
- …reflected. Works directly with House Supervisors to provide appropriate and timely admission to the facility taking into account current census, inpatient emergency ... include all ICARE Values, culture of 'yes' to accommodate physician partners/patient admissions . Provides timely feedback to staff and works to support their… more
- Generis Tek, Inc. (El Paso, TX)
- …calls with patients and/or families as needed You will complete accurate and timely utilization review of patient charts to insure appropriate utilization of ... this amazing opportunity, reach out to our Talent Acquisition Specialist Anshik Kulshrestha at email address ###@generistek.com can be...to 3rd party payers in support of the patient's admission and/or continued hospital stay You will have active… more
- Franciscan Missionaries of Our Lady Health System (Baton Rouge, LA)
- Job Description The HMS Patient Throughput Specialist coordinates referrals from ER Physicians, Community Physicians, and other Healthcare Providers to the Hospital ... demographic and financial information. Also maintains strong understanding of bed management/ utilization an patient flow methodologies as they relate to continuum of… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team. The Utilization ... and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- Hunterdon Health Care System (Flemington, NJ)
- Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure the effective and efficient ... use of hospital services and monitors the appropriateness of hospital admissions and extended hospital stays. The evaluation of the appropriateness and medical… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is ... responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients...and advocating for appropriate levels of care. The UR Specialist works closely with clinical staff, admissions ,… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Nuvance Health (Danbury, CT)
- …by using bench marked evidence-based criteria (ie, InterQual/MCG). Responsibilities: 1)Ensures that Admission Review using InterQual, or MCG is completed within ... other duties as required. Education: ASSOCIATE'S LVL DGRE Required: 3 Years of Utilization Review experience(or a certification ACMA, MCG, Interqual) Required :… 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 ... our patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! As our… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services ... to ensure compliance with utilization management policies. This role conducts admission ...healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence… more
- Community Health Systems (Franklin, TN)
- …timely authorizations for hospital admissions and extended stays. The Utilization Review Coordinator monitors and documents all authorization activities, ... authorizations and reduce potential denials, utilizing input from the Utilization Review Clinical Specialist . +...Degree preferred + 0-2 years of work experience in utilization review , hospital admissions or… more
- Alameda Health System (Oakland, CA)
- …review of requests that may not meet medical necessity criteria. 4. Review admission orders and documentation to confirm alignment with regulatory ... System Utilization Management SUM Specialist + Oakland,...and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of… 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 Type: ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,... in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates with… more
