- Luminis Health (Lanham, MD)
- …to hiring, evaluating performance, issuing final disciplinary actions under the review of Human Resources, and recommending discharge in collaboration with members ... and developmentally experience/opportunities. . Demonstrates the ability to optimize utilization of staff, matching staff talents and proficiencies to organizational… more
- Luminis Health (Lanham, MD)
- …to hiring, evaluating performance, issuing final disciplinary actions under the review of Human Resources, and recommending discharge in collaboration with members ... coaching and developmentally experience/opportunities. .Demonstrates the ability to optimize utilization of staff, matching staff talents and proficiencies to… more
- Campbell County Health (Gillette, WY)
- …Coordinator focuses on integrating care management, social services, discharge planning, utilization review and post-hospital services to ensure clinical ... (increases with tenure) * Paid sick leave days * Medical /Dental/Vision * Health Savings Account, Flexible Spending Account, Dependent...empowerment of resident in self-management of disease process. * Utilization review of the resident stay is… more
- Saint Vincent Hospital (Worcester, MA)
- …are so many stories of compassionate care; so many "firsts" in terms of medical innovation; so many examples of enhancing healthcare delivery and shaping a business ... of care. We are differentiated by our top notch medical specialists and service lines that are tailored within...patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and… more
- Integra Partners (Troy, MI)
- …as operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director(s), ensures consistent application of ... representing Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director's responsibilities include but… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support ... and are committed to consistency, compliance, and evidence-based decision making. The Utilization Review Medical Director 's responsibilities include but… more
- Logan Health (Kalispell, MT)
- …regarding CDI queries in a professional, collaborative manner + Partnering with the Chief Medical Officer on utilization review initiatives, length of stay ... as our Manager of Clinical Documentation Integrity (CDI) & Utilization Review ! This role is ideal for...is an in-person position located within our Logan Health Medical Center at 310 Sunnyview Lane, in beautiful Kalispell,… more
- Highmark Health (Bismarck, ND)
- …determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update ... prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical...At times, the incumbent may conduct additional research beyond medical policy review to make coverage determinations.… more
- The County of Los Angeles (Los Angeles, CA)
- …recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the committee of new or ... REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse* or Medical Service Coordinator, CCS.** -OR- OPTION II:… more
- Spectrum Billing Solutions (Skokie, IL)
- …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing...and skilled individuals. + Growth opportunities + Benefits - Medical , Dental, Vision + Flexible Paid Time Off +… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …II (in addition to Level I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of ... recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range… more
- The Cigna Group (Bloomfield, CT)
- …not be included in CMS' Preclusion List** **Preferred Skill Sets:** + Experience in medical management, utilization review and case management in a managed ... (CHC) -- Cigna. **Summary description of position** : A Medical Principal performs medical review ...will serve as a clinical educator and consultant to utilization management, case management, network, contracting, pharmacy, and service… more
- Molina Healthcare (Rio Rancho, NM)
- …+ At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports ... JOB DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal… more
- Katmai (Fort Carson, CO)
- …access to care standards for appropriate utilization of services. Perform utilization management/ review for medical necessity for specialty referrals and ... **SUMMARY** Provide a comprehensive utilization review (UR) and utilization...Working knowledge of EHR Genesis desirable. + Knowledge of Medical Terminology. **WORK** **SCHEDULE** Full-time. May be required to… more
- AmeriHealth Caritas (Washington, DC)
- …Systems to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care ... **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity...ability to meet productivity standards in a fast-paced, high-volume utilization review environment + Proficiency using MS… more
- SUNY Upstate Medical University (Syracuse, NY)
- …patients, maintaining accurate attendance and therapy records. Interfaces with nursing, medical staff, utilization review social services, discharge ... progress through written and verbal reports and through documentation in the medical record. Plan and schedule patient therapy based on individual needs. Schedules… more
- Texas Health Resources (Dallas, TX)
- …histories from all available resources. Assesses patient information utilizing psychological and medical knowledge. Utilization Review and Management * ... Performs effective utilization review according to department identified criteria to determine the...status if criteria is met. Makes appropriate referrals to Medical Director of Case Management for admission status determinations.… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print...over the nursing staff engaged in utilization review activities at Los Angeles General Medical ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,457.04 - $177,314.88 Annually… more
- CareFirst (Baltimore, MD)
- …with Appeals and Grievances in a healthcare payor organization. 2 years' experience in Medical Review , Utilization Management or Case Management at CareFirst ... (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Medical Review **Equal Employment Opportunity** CareFirst BlueCross… more
- New York State Civil Service (Syracuse, NY)
- NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), Hutchings Psychiatric Center, P26038 Occupational Category Health ... Code 13210 Duties Description Hutchings Psychiatric Center is recruiting for a Utilization Review Coordinator to analyze and evaluate quality, effectiveness, and… more
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