- Penn Medicine (Lancaster, PA)
- …each day. Are you living your life's work? Summary: + Position Summary: The Utilization Management Specialist - Denials is responsible for evaluating medical ... insurance benefit structures and related legal medical issues. + Knowledge of utilization management and quality improvement processes. + Experience working… more
- Vanderbilt University Medical Center (Nashville, TN)
- …is to advance health and wellness through preeminent programs in patient care, education , and research. **Organization:** Utilization Management 20 **Job ... * Facilitates throughput of patients admitted urgently or emergently through the emergency department . * Participates as an active partner with multidisciplinary… more
- Sanford Health (Sioux Falls, SD)
- … and potentially, prior authorization. Assists the department in monitoring the utilization of resources, risk management and quality of care for patients in ... Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Utilization Management Specialist , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: ... East Tennessee to be named a Forbes "Best Employer" seven times. Position Summary: The Utilization Management Specialist I will perform utilization … more
- Sharp HealthCare (San Diego, CA)
- **Facility:** Copley Drive **City** San Diego ** Department ** **Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Driver's License ... - CA Department of Motor Vehicles; HS Diploma or Equivalent; Bachelor's...an applicant's years of experience, unique skills and abilities, education , alignment with similar internal candidates, marketplace factors, other… more
- Commonwealth Care Alliance (Boston, MA)
- …Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager, Utilization Management reports to the Director of … more
- UPMC (Pittsburgh, PA)
- UPMC St. Margaret is seeking a full-time Clinical Pharmacist to join our Emergency Department team! In this dynamic role, you will be responsible for managing ... daily pharmacy operations and providing direct clinical support within the Emergency Department . As a faculty member of the Pharmacy Residency Program, you will… more
- Integra Partners (Troy, MI)
- …to join our Operations Training & Development team as an Operations UM Training Specialist , specializing in Utilization Management (UM) processes. The ideal ... industry standards, regulatory requirements, and best practices in clinical documentation and utilization management and update training documents as required +… 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 ... a cancer care network, outpatient surgery centers, clinical research, medical education , a foundation, an accountable care organization, community services and more.… more
- Trinity Health (Ann Arbor, MI)
- …clinical, age specific, developmental, cultural and spiritual needs. Facilitates utilization management documentation and appropriate communication with external ... knowledge of rules, regulations, policies, and procedures related to utilization management work processes and criteria. +...by Case Manager. + Supports Social Work & Case Management Department and patient care by providing… more
- St Joseph's Addiction Treatment & Recovery Centers (Saranac Lake, NY)
- …by Supervisor, supporting the agency's mission and client care quality. Department Utilization Review Employment Type Full-Time Minimum Experience Mid-level ... Centers Location: Inpatient Facility - Saranac Lake, NY Position: Full-time Utilization Review Specialist Shift/schedule: Monday-Friday, 8:00am-4:30pm Pay Range:… more
- Nuvance Health (Danbury, CT)
- *Description* Summary: The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary team, and organization with the ... of care and providing timely and accurate clinical information to payors. Utilization management provides clinically based first level medical necessity reviews… more
- Granville Health System (Oxford, NC)
- …of the job require clinical skills to consumers who report in crisis in GHS Emergency Department . #Case management and support services for Transitional Care ... ED physician, to patients who present to the Emergency Department including recommendations for level of...regarding these. 15. Assists with transfer arrangements for case management patients. 16. Provides input into resource utilization… more
- Granville Medical Center (Oxford, NC)
- …of the job require clinical skills to consumers who report in crisis in GHS Emergency Department . Case management and support services for Transitional Care ... ED physician, to patients who present to the Emergency Department including recommendations for level of...regarding these. 15. Assists with transfer arrangements for case management patients. 16. Provides input into resource utilization… more
- LifePoint Health (Sylva, NC)
- …partnership with the ED physician, to patients who present to the Emergency Department including recommendations for level of care needs 2. Completes ... abuse assessment, diagnosis, and crisis intervention to patients/families identified by the Emergency Department or Medical floor as having psychiatric and/or… more
- Katmai (Fort Carson, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... background checks. **DESIRED QUALIFICATIONS & SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in Healthcare… more
- State of Colorado (Denver, CO)
- Quality Management Specialist / Occurrence Reporter (HEALTH PROFESSIONAL III) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4942850) Apply ... Quality Management Specialist / Occurrence Reporter (HEALTH PROFESSIONAL...The Joint Commission. Collaboration and Training Participates in Quality Management Department meetings. + Provides consultation and… more
- Avera (Sioux Falls, SD)
- …Appeals Specialist to ensure tracking and trending of all Utilization Review related denials/appeals are appropriately documented. + Assists with the collection ... with clinicians and financial team members including the Pre-anesthesia Department , Surgery Scheduling, Clinical Departments, physicians, payers, Patient Access,… more
- Parkview Health (Fort Wayne, IN)
- …scheduling, and ED software preferred. Experience in pre-certification, utilization , or case management desirable. Previous coding experience desirable. ... Summary: The Patient Placement Specialist will be responsible for daily patient flow,...by triaging and supporting ICU capacity, OR throughput and ED decompression with the overall end point of supporting… more
- HCA Healthcare (Dallas, TX)
- **Description** **Clinical Pharmacist Specialist BMT** **BMT Experience required** **PRN Position** **Introduction** Experience the HCA Healthcare difference where ... of each individual is recognized. Submit your application for our Clinical Pharmacist Specialist BMT PRN opening with Medical City Dallas today and find out what… more