- 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
- Ochsner Health (New Orleans, LA)
- …Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (3) Physician Advisor Sub-Specialty Certification by ... the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (4) commitment...MCG / InterQual screening criteria, Medicare / Medicaid compliance, medical staff structure, policies and procedures + Physician… 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
- Intermountain Health (Las Vegas, NV)
- …appeals levels 1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims ... care management, claims, network management, and finance. As the Medical Director for Utilization Management, you are...review , quality assurance, and medical review of complex, controversial, or experimental 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
- 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
- Houston Methodist (The Woodlands, 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
- 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
- HCA Healthcare (Nashville, TN)
- **Description** **Introduction** Do you have the career opportunities as a(an) Utilization Review Services RN you want with your current employer? We have an ... of colleagues. Do you want to work as a(an) Utilization Review Services RN where your passion...**What you will do in this role:** + Conduct medical record review , validate admission status order,… more
- University of Utah Health (Salt Lake City, UT)
- …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
- 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) ... every 3rd weekend rotation Summary: The purpose of the Utilization Management Nurse is to support the physician...Education: ASSOCIATE'S LVL DGRE Preferred : Two Years of Utilization Review experience Required : CT Registered… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …and leadership programs + And more! **Description** The **Registry Utilization Review Nurse** (PRN) is responsible for conducting medical necessity reviews ... chart, clinical nursing judgement, and discussions with the attending physician and/or physician advisor. + The UR... advisor. + The UR RN (PRN) will perform utilization review by completing a timely and… 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 (Washington, DC)
- …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! ... **Responsibilities** Are you a skilled and experienced Utilization Review Specialist looking for a...you will be responsible for conducting comprehensive reviews of medical records using evidence-based guidelines and critical thinking to… more
- Trinity Health (Columbus, OH)
- …of the Sr. Director of Medical Management. + Coordinates with the utilization review , case management, discharge planning staff within network facilities. + ... analysis, audit, provider relations and more. **Position Purpose** RN Utilization Review MCHP is responsible for the...preferred. Demonstrated ability to analyze, summarize and concisely report medical utilization and medical chart… more
- R1 RCM (Boise, ID)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Author** , you will help our hospital ... experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines...position. **Here's what you will experience working as a Utilization Review Author:** + Perform initial admission… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of ... high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation,… more
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