- Beth Israel Lahey Health (Plymouth, MA)
- …you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding UR… more
- Beth Israel Lahey Health (Plymouth, MA)
- …is expanding its **Care Transitions Department** and seeking an experienced ** Manager of Utilization Review & Denials Management** and ** Utilization ... or other case management certification preferred or in progress ** Manager - Utilization Review & Denials Management** This role is ideal for a Manager… more
- Hartford HealthCare (Farmington, CT)
- …practices. *_Position Responsibilities:_* *Key Areas of Responsibility* *Denial Resolution* . Review DRG validation denials from payers, analyze the denial ... The Denial Specialist 2 is responsible for reviewing, analyzing, and appealing denials related to DRG (Diagnostic Related Group) validation denials . This… more
- AdventHealth (Glendale Heights, IL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... and financial indicators including LOS, cost per case, avoidable days, resource utilization , readmission rates, concurrent denials , and appeals. *Uses data to… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... this position is able to cover a multitude of utilization review functions through point of entry,...plan of care and ensures prompt notification of any denials to the appropriate case manager , … 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
- Dignity Health (Carmichael, CA)
- **Responsibilities** **Day Per Diem Utilization Review Registered Nurse - Onsite Campus Position** The ** Utilization Review RN** is responsible for the ... Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies + Collaborates with...admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the… more
- Children's Hospital Boston (Boston, MA)
- …Posting Title:Per Diem RN Case Manager , Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard ... denials . They identify and implement initiatives to manage utilization trends, collaborating with the hospital's discharge planning case managers, healthcare… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... plan of care and ensures prompt notification of any denials to the appropriate case manager , ...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review Full Time Days - 2506001796 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves ... 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
- UNC Health Care (Chapel Hill, NC)
- …care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management ... needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Evening + ... FTE:1 + Posted:July 14, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review ...in orientation of fresh staff as requested by the Manager of Utilization Management. 17. Maintains knowledge… more
- Baptist Memorial (Meridian, MS)
- Overview RN Utilization Review Weekender Job Code: 22818 FLSA Status Job Family: NURSING Job Description Title: RN Utilization Review Weekender Job ... necessity and appropriateness of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works with providers, insurance… more
- Beth Israel Lahey Health (Burlington, MA)
- …collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities ... the context of other Revenue Cycle functions such as Denials & Appeals, Patient Access, Authorization Management & ...Responsibilities** _including but not limited to:_ + Ensures that Utilization Review nurses are consistently recommending the… more
- Ochsner Health (Lafayette, LA)
- …compliance management systems (CMS) regulations, compliance and quality metrics. Experience managing denials and appeals of all payer cases in a timely and organized ... + Determines appropriate staffing levels and the interviewing, hiring, performance review , and termination of employees within practice unit(s); maintains employee… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- UNC Health Care (Hendersonville, NC)
- …the health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge ... in accordance with federal regulations and the health system's Utilization Review Plan. Responsibilities: + Uses approved...patient data and treatments. Communicates daily with the Care Manager to manage level of care transitions & appropriate… more
- Beth Israel Lahey Health (Plymouth, MA)
- …care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care ... the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established… more
- Mount Sinai Health System (New York, NY)
- …department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status of Medical ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based guidelines, insurance ... business acumen, and high level of communication skills to ensure appropriate utilization of and reimbursement for resources from admission through hospital stay to… more