- Acadia Healthcare (Indian Wells, CA)
- …support so you can achieve your greatest potential. This role can be an Admissions Counselor, Admissions Specialist or Admissions RN. Responsibilities ... certification required (training available upon hire and offered by facility). Admissions Specialist : Bachelor's degree in Behavioral Science, Social Work,… more
- Children's Health (Dallas, TX)
- …Summary: The Prospective Review Nurse is responsible for conducting utilization review of scheduled inpatient services requested by Physician/Provider in ... audits of medical records as directed; and assists the Utilization Review Team Lead, Prior Authorization and...setting/level of care based on complex or high cost admissions . * Accountable for current knowledge of utilization… more
- Conifer Health Solutions (Sherwood, AR)
- …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
- State College of Florida Manatee-Sarasota (Bradenton, FL)
- …and essential functions are subject to change due to advances in technology, utilization of work force, and other factors which may impact the College's need ... tutoring, study coaching, and supplemental instruction initiatives. Develop study and review materials for use in these initiatives. Maintains expert knowledge in… 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
- 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
- LifePoint Health (Louisburg, NC)
- Registered Nurse (RN) Utilization Review Job Type: Full Time | Day Your experience matters At Maria Parham Hospital, we are driven by a profound commitment to ... of those we serve. Connect with our RN recruiting specialist . Do you need more time to complete an...the responsibilities involved in monitoring adherence to the hospital's utilization review plan, which ensures the appropriate… more
- HCA Healthcare (Richmond, VA)
- …acute inpatient rehabilitation services prior to returning home. The Clinical Rehabilitation Specialist will review these patients daily until they have strong ... Specialist will assist and coordinate the in-take and pre- admission screening process. The Clinical Rehabilitation Specialist accurately documents… more
- HCA Healthcare (Nashville, TN)
- …for patients in regard to managed care organizations + Conducts utilization review for managed care cases in admissions /intake department + Willingness to ... treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile… more
- Penn Medicine (Lancaster, PA)
- …day. Are you living your life's work? Summary: + The Home Health Quality Specialist is responsible for collaborating with clinicians at established points in time to ... and development of effective plans of care to assure appropriate utilization and promote appropriate qualitypatient care and positive patient outcomes.… more
- Trinity Health (Troy, NY)
- …college level course in medical terminology. + One year of case management or utilization review /billing or coding experience. + One year of experience in ... utilization reviews with the facilities Per Diem- Insurance Specialist to assist with authorizations for Substance abuse and...related field + One year of case management or utilization review , billing, or coding experience Please… more
