- Premera Blue Cross (Mountlake Terrace, WA)
- …bundling edits, and recommend action steps regarding code configuration issues, annual utilization and review analysis. + Maintain current knowledge of coding ... procedure and diagnosis codes, and support business decisions regarding utilization management activities and guidelines. + Support medical policy development… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Nuvance Health (Danbury, CT)
- …the time of review . If unable to resolve, escalate to the PA and Utilization Review (UR) Leadership. * Coordinate with the care team in changing patient ... This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to...Guidelines required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care… more
- Veterans Affairs, Veterans Health Administration (Smyrna, TN)
- …of functions, and the integration of VHA and industry best standards. The Revenue Utilization review (RUR) Registered Nurse (RN) is an active member ... with 5 years nursing experience. 1-3 years of relevant case management or utilization review experience. Ability to collaborate effectively and communicate with… more
- Cedars-Sinai (Los Angeles, CA)
- …Repetitive Motions, Eye/Hand/Foot Coordination **Req ID** : 14355 **Working Title** : Registered Nurse - Utilization Review Case Manager - 8 Hour Days ... of America's Best Hospitals. Summary of Essential Duties: + The Utilization Management (UM) Registered Nurse - Medicare Short Stay & Concurrent Denials … more
- George C. Grape Community Hospital (Hamburg, IA)
- Quality/ Utilization Review Nurse Position Summary: The Quality/ Utilization Review Nurse is responsible for evaluating the medical necessity, ... to infection prevention protocols and regulatory compliance. Key Responsibilities: * Utilization Review : o Conduct concurrent and retrospective reviews of… more
- Northwell Health (Melville, NY)
- …level of care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. + Performs concurrent and retrospective ... + Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications...4+ years preferred. + Prior Acute Case Management and/or Utilization Review experience, preferred. + Must have… more
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the...Performance Tracking and Improvement: Provides analysis and reports of utilization , denials , and appeals KPIs, trends, patterns,… more
- Northwell Health (Melville, NY)
- …level of care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. Performs concurrent and retrospective ... of illness and intensity of services provided. Performs PRI's (Patient Review Instrument), as needed. Performs related duties as required. All responsibilities… more
- Houston Methodist (Katy, TX)
- At Houston Methodist, the Director Centralized Utilization Review (UR) position is responsible for strategic, administrative, and operational leadership for the ... Houston Methodist system. This position oversees all aspects of utilization review to ensure medical necessity, level... or billing delays. Provides oversight for the concurrent denials and short stay review process in… more
- Dartmouth Health (Lebanon, NH)
- …with pre-certifications. * Assumes responsibility for the oversight of inpatient denials , including, but not limited to, reviewing denial letters, collaborating with ... communication and computer skills desired. Required Licensure/Certifications - Licensed Registered nurse with NH eligibility * Remote:Fully Remote * Area of… more
- Houston Methodist (Katy, TX)
- At Houston Methodist, the Manager Centralized Utilization Review (UR) position is responsible for leading the daily operations of the Utilization Review ... and payer requirements. Reporting to the Director of Centralized Utilization Review , the Centralized Manager, UR position...abilities **LICENSES AND CERTIFICATIONS** **Required** + RN - Registered Nurse - Texas State Licensure - Texas Board of… more
- Sanford Health (Rapid City, SD)
- …Full time **Weekly Hours:** 40.00 **Department Details** Join our team as a Utilization Review and Case Management Manager and lead a high-impact, data-driven ... One year of leadership/management experience preferred. Experience in medical necessity review preferred. Currently holds an unencumbered registered nurse (RN)… 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 ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review - Case Management - 2506004107 Description : Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse ... level of care, length of stay and authorization Prevents denials and disputes by communicating with payors and documenting...level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional Care Team.This is a full-time role and will be required to work ... this position: *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Manager of Utilization Review oversees a team of utilization review nurses and coordinators, ensuring compliance with clinical ... regulatory standards, and enhancing the overall utilization review process to optimize patient care...supports and coordinates the various aspects of the hospital's utilization management program, denials and appeals activities.… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... the supervisor including but not limited to processing concurrent denials . + Preferred experience includes Critical Care or Emergency...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
