- Cytiva (Miami, FL)
- …in Muskegon, MI and will be an on-site role. What you will do: Review and approve user requirement documentation (URS), Failure Mode Effect Analysis (FMEA) and ... Practices (GMP), and Good Documentation Practices (GDP) requirements.Travel, Motor Vehicle Record & Physical/Environment Requirements:Ability to travel up to 10% a… more
- LA Care Health Plan (Los Angeles, CA)
- … medical and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management ... Medical Review Nurse Coder RN III... Medical Review Nurse Coder RN III (Payment Integrity Nurse)...position serves as a subject matter expert (SME), performing medical records reviews to include quality audits… more
- Commonwealth Care Alliance (Boston, MA)
- …to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for providing ... **Essential Duties & Responsibilities:** + Primary responsibility for performing daily medical reviews, appeals as appropriate, correspondence regarding review … more
- San Antonio Behavioral Health (San Antonio, TX)
- …the interaction with claims payment policies and processes. Directs activities related to medical review process while monitoring the timeliness and accuracy of ... The Director of Utilization Review (UR) in a behavioral health setting oversees...contractual protocols . Audits Medicare files by verifying initial medical necessity: certifications of all Medicare admissions, re-certifications of… more
- HCA Healthcare (Nashville, TN)
- …geographical market and productivity. **What you will do in this role:** + Conduct medical record review , validate admission status order, conduct a ... and mitigation of concurrent denials. This involves assessing the medical record for appropriateness and level of...medical necessity review and provide clinical information to the payor +… more
- Houston Methodist (The Woodlands, TX)
- …is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of ... or concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical guidelines,… more
- Truman Medical Centers (Kansas City, MO)
- …to data analysis, reporting, and community-based action planning. **What You'll Do** + Review medical records and conduct interviews with families to ... support efforts in understanding and preventing fetal and infant deaths. You'll gather, review , and summarize sensitive medical records and conduct… more
- Children's Mercy Kansas City (Kansas City, MO)
- …management of patients, including patient statusing processes, ongoing monitoring of medical necessity review functions utilizing InterQual and/or MCG screening ... quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome focused family… more
- AmeriHealth Caritas (Philadelphia, PA)
- …applications in a Windows based environment. + Proficiency utilizing electronic medical record (EMR) and clinical documentation programs.; **Diversity, Equity, ... the shift care workflow the case is presented to the Medical Director for medical necessity review . Upon approval of services, responsibilities include… more
- CommonSpirit Health Mountain Region (Colorado Springs, CO)
- …of risk management and regulatory agency requirements/standards. Experience with electronic medical record systems and knowledge of clinical/ medical ... to ensure quality patient care by effectively managing the Medical Staff's Peer Review Program, which encompasses...by effectively managing the Medical Staff's Peer Review Program, which encompasses the ongoing and focused professional… more
- Commonwealth Care Alliance (Boston, MA)
- …Review will review behavioral health and substance use admissions for medical necessity and appropriate levels of care and assist with transition of care ... health managed care preferred + Experience in behavioral health utilization review or medical necessity evaluation preferred **Required Knowledge, Skills… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and… more
- UCLA Health (Los Angeles, CA)
- …including inspections of clinical areas, patient care practices, and administrative processes + Review medical records of services in preparation for health ... include: + Travel to various clinic sites and schedule and conduct medical record and facility site audits + Conduct thorough facility site reviews and… more
- Providence (Mission Hills, CA)
- …and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records daily during admission for all payers, ... **Description** RN - Utilization Review for our centralized Utilization Management team for Southern California. This position is Remote (Working from Home 100%) and… more
- Medical Mutual of Ohio (OH)
- …the continuum of care. **Responsibilities** + Independently evaluates basic to complex medical claims and/or appeal cases and associated records by applying ... of stay and level of care. + Extrapolates and summarizes medical information for physician review or other external review . + Generates appropriate written… more
- Gilead Sciences, Inc. (Foster City, CA)
- …to enable timely, informed decisions and improved patient outcomes + Performs appropriate medical review for promotional and/or medical materials + Prepares ... possible, together. **Job Description** **Job Overview** **:** + Responds to unsolicited medical requests regarding Gilead products from HCPs, members of the public,… more
- Gilead Sciences, Inc. (Foster City, CA)
- …to enable timely, informed decisions and improved patient outcomes . Performs appropriate medical review for promotional and/or medical materials . Prepares ... possible, together. **Job Description** **Job** **Overview** . Responds to unsolicited medical requests regarding Gilead products from HCPs, members of the public,… more
- Centene Corporation (Jefferson City, MO)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. +...by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA… more
- The County of Los Angeles (Los Angeles, CA)
- …direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of ... for and the effective conduct of the system to review patients' medical charts to ascertain the...SECURITY NUMBER: Please include your Social Security Number for record control purposes. Federal law requires that all employed… more
- The County of Los Angeles (Los Angeles, CA)
- …authorization for the issuance of denial letters. + Reviews, retrospectively, utilization review records for completeness, use of appropriate codes, correctness ... physician advisor for follow up on referrals. + Reviews, retrospectively, Utilization Review Records for completeness, use of appropriate codes, correctness of… more
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