- Novo Nordisk Inc. (Walnut Creek, CA)
- …other field-based employees (eg, DBMs, DCSs, Market Access Team, Diabetes Educators, Medical Liaisons) covering the same geographic areas. The Specialty Field Sales ... and unique insights Leverages superior understanding of complexities within the targeted physician customer base in order to maximize performance Applies high level… more
- Sutter Health (Sacramento, CA)
- …expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical necessity, documentation best practices, level ... physician Advisor will work closely with the medical staff, including house staff, and all utilization...within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation… more
- Hackensack Meridian Health (Hackensack, NJ)
- The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical ... records for the patient population and Hackensack University Medical Center. These include but are not limited to... Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case… more
- Commonwealth Care Alliance (Boston, MA)
- … Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for providing leadership and ... medical reviews, appeals as appropriate, correspondence regarding review determinations and physician peer review...Serve as the lead for CCA's Utilization Review functions working closely with other medical … 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 ... Medi-Cal reimbursement. + Analyzes cases for referral to the physician advisor to ensure that the admission or continued...I:One year of experience performing the duties of a Utilization Review Nurse* or Medical … more
- The County of Los Angeles (Los Angeles, CA)
- …administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the ... Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician...for and the effective conduct of the system to review patients' medical charts to ascertain the… more
- UPMC (Pittsburgh, PA)
- The Regional Medical Director, CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. This ... between managed care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote adherence to URAC… 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 ... concurrent medical record review for medical ...this position is able to cover a multitude of utilization review functions through point of entry,… 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 ... medical record review for medical ...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
- AdventHealth (Glendale Heights, IL)
- …pending denials, which have been referred to the physician for peer-to-peer review with the Medical Director of the insurance carrier. Qualifications **The ... the UM nurse is responsible for escalation to the Physician Advisor or designated leader for additional review...of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines,… more
- Trinity Health (Des Moines, IA)
- …(IA), MercyOne Des Moines Join the MercyOne Family! We are looking to hire a Utilization Review RN! Responsible for the review of inpatient and outpatient ... the Case Management staff utilizing admission criteria guidelines-and second level physician review process when appropriate. Interacts with insurance providers… more
- Dignity Health (Carmichael, CA)
- **Responsibilities** **Day Per Diem Utilization Review Registered Nurse - Onsite Campus Position** The ** Utilization Review RN** is responsible for the ... review of medical records for appropriate admission status and continued hospitalization....admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the… more
- Alameda Health System (Oakland, CA)
- …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating ... System Utilization Management SUM Utilization Review...cases to the internal/external Physician Advisor for review of requests that may not meet medical… more
- Baptist Memorial (Meridian, MS)
- …RN Utilization Review Weekender Job Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and appropriateness of ... Overview RN Utilization Review Weekender Job Code: 22818...and appropriate care. Areas of work include status management, medical necessity reviews, verification of authorization, resource utilization… more
- Nuvance Health (Danbury, CT)
- …any issues/denials to department leadership.* 12) Forwards reviews that require secondary physician review to appropriate resource ( Physician Advisor) 13) ... one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the physician...required. Education: ASSOCIATE'S LVL DGRE Required: 3 Years of Utilization Review experience(or a certification ACMA, MCG,… more
- Covenant Health (Nashua, NH)
- …health care team. + Annual goals are achieved. + Attends pertinent case management/ utilization review programs to maintain current knowledge of UR practices. + ... medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed...+ Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all… more
- Baptist Memorial (Memphis, TN)
- …of Position and Scope of Responsibility Job Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and appropriateness ... of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works with providers, insurance companies and patients to ensure… more
- AmeriHealth Caritas (LA)
- …Systems to efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care ... for approval or denial decisions. + Identify and escalate complex cases requiring physician review or additional intervention. + Ensure compliance with Medicaid… more
- Catholic Health Initiatives (Omaha, NE)
- …for our patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! ... 2 hours of a Commonspirit Health Facility Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact patient… more
- Trinity Health (Athens, GA)
- **Employment Type:** Part time **Shift:** **Description:** The Utilization Review (UR) Coordinator works, in collaboration with a multidisciplinary team that ... in denials management and auditing duties as assigned. Participates in the Utilization Review Committee as assigned. Maintains good rapport and cooperative… more
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