- 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
- Hackensack Meridian Health (Hackensack, NJ)
- **The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Hackensack Meridian Health (Hackensack, NJ)
- …(APN) or Physician Assistant (PA) for the Transition Utilzation Review Team utilizes a patient-centered coordinated care model, demonstrating competencies in ... Knowledge, Skills and Abilities Required: 1. Successful completion of an approved physician 's assistant program, accredited by the AMA Council on 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
- 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
- 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
- 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...intensity of services, escalating cases as necessary to payers, physician advisors, leadership, or the medical team.… more
- St. Peters Health (Helena, MT)
- …with the MD advisor or physician consultant(s) on any cases sent for physician review . 4. Performs daily utilization reviews on all patients admitted ... The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN...admission status and identifies related quality measures to promote medical compliance. 14. Collaborates with admitting physician ,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …professional development specialist to develop standard work and expectations for the utilization review process, including timely medical necessity ... actions to UR Committees, as appropriate * Partners with Physician Advisor to engage in second level review...with payers, as appropriate * May participate in the Utilization Review Committee to present medical… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review - Case Management -... Medical Necessity and submits case for Secondary Physician review per Tenet policy Ensures timely ... management system Follows the payor dispute processes utilizing secondary medical review , peer to peer and payor...level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... provision of quality based patient care focusing on the medical necessity and efficiency of the delivery of such...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC...measures to achieve target. + Presents LOS variances for review to Director and Inpatient Medical Director. ... or observation in Community Hospitals and UTMB-TDCJ Hospital. + Performs utilization review procedures by prospectively, concurrently, and retrospectively… more
- CommonSpirit Health (Phoenix, AZ)
- …by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. + Physician Advisor Sub-specialty Certification ... an expert on matters regarding physician practice patterns, over and under- utilization of resources, medical necessity, levels of care, care progression,… more
- UNC Health Care (Kinston, NC)
- …support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established ... levels of an audit appeal. Works collaboratively with the Physician Advisors and subject matter experts for all audit...experience as a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
- Covenant Health Inc. (Knoxville, TN)
- …coordinators, physician advisors and facility departments as related to utilization management. Communicates with hospital and payor medical directors in ... meetings between physicians and payors as applicable. + Completes daily work lists for utilization review meeting the time frames set forth by Covenant Health. +… more
- UNC Health Care (Morrisville, NC)
- …People** - Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate and empower ... Executive Director works closely with leaders from various departments-case management, physician advisors, revenue cycle, medical staff, nursing, and… more
- UNC Health Care (Raleigh, NC)
- …the Utilization Manager is responsible for revenue protection by reconciling physician orders, bed billing type, and medical necessity. This may include ... Advisor as necessary to resolve barriers through appropriate administrative and medical channels. 4. Utilization Outcomes Management - Monitors and guides… more
- Fallon Health (Worcester, MA)
- …+ Responsible for hiring appropriate non- physician clinical and non-clinical personnel to review medical cases and determine if requests for services meet ... operations, including but not limited to prior authorization, concurrent review and discharge planning. + Ensures that members get...and prioritize the cost of care opportunities related to Utilization Management. + Works with VP/ Medical … more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... utilization reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance with industry… more
- AnMed Health (Anderson, SC)
- …Performs assigned utilization management functions daily: initial, concurrent and retrospective review of the medical record with speed and accuracy for all ... and transfers. + Uses clinical knowledge to independently review the medical record for clinical appropriateness and resource utilization including but not… more
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