- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services ... to ensure compliance with utilization management policies. This role conducts admission ...healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence… more
- Spectrum Billing Solutions (Skokie, IL)
- …Excel, billing software). + Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management ... a remote or office/home hybrid position. Your Responsibilities: + Review patient admission and clinical information to... | UR Specialist | Revenue Cycle Utilization Review Specialist | ABA… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is ... responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients...and advocating for appropriate levels of care. The UR Specialist works closely with clinical staff, admissions ,… more
- Community Health Systems (Franklin, TN)
- …timely authorizations for hospital admissions and extended stays. The Utilization Review Coordinator monitors and documents all authorization activities, ... authorizations and reduce potential denials, utilizing input from the Utilization Review Clinical Specialist . +...Degree preferred + 0-2 years of work experience in utilization review , hospital admissions or… more
- Penn Medicine (Lancaster, PA)
- …and thrive under pressure, we'd love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible for evaluating ... is looking for an experienced RN to join our Utilization Management Specialist team! In this critical...accommodation to perform the following duties:** + Complete chart review and communicate patient status medical needs with insurance… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,... in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates with… more
- St. Peters Health (Helena, MT)
- …members are out of the office. 2. Complete comprehensive review of all admissions to SPH. These are evaluated for admission status. 3. Follow-up daily on ... The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN...orders when appropriate; continued stay reviews for cases where admission exceeds the GMLOS, documentation of avoidable, initiation of… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional Care Team.This is a full-time role and will be required to work ... this position: *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include… 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 ... dollars and appeal win rates. 12. Assists in documentation review in the clinical documentation specialist role...experience as a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
- HCA Healthcare (Largo, FL)
- …and personal growth, we encourage you to apply for our Clinical Rehab Specialist PRN opening. We review all applications. Qualified candidates will be ... have the PRN career opportunities as a(an) Clinical Rehab Specialist PRN you want with your current employer? We...to ensure a responsive and smooth flowing referral and admission process for the inpatient acute rehab program. +… more
- SUNY Upstate Medical University (Syracuse, NY)
- …including PC, Windows, Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, ... Job Summary: The UR-CR Specialist I is primarily responsible for ensuring that...reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria… more
- HCA Healthcare (Nashville, TN)
- …for patients in regard to managed care organizations + Conducts utilization review for managed care cases in admissions /intake department + Willingness to ... treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile… more
- Nuvance Health (Danbury, CT)
- …the time of review . If unable to resolve, escalate to the PA and Utilization Review (UR) Leadership. * Coordinate with the care team in changing patient ... payer behaviors to internal leadership for assistance in resolution *Responsibilities:* * Review all inpatient admission and observation cases using InterQual,… more
- University of Miami (Miami, FL)
- …received via in-basket messaging. + Extensive collaboration with providers, nursing unit, and utilization review department in coordinating admissions . CTU + ... confirming, and documenting eligibility and benefits, and providing health plan admission notification. + Responsible for pre- admissions log to include… more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Hackensack Meridian Health (Red Bank, NJ)
- … admissions and observations as specified by the facility's Utilization Management/ Review Committee for documentation completeness and compliance with ... and serve as a leader of positive change. The **Clinical Documentation Specialist RN** facilitates improvement in the overall quality, completeness and accuracy of… more
- HCA Healthcare (Tallahassee, FL)
- …is important to you, we encourage you to apply for our Clinical Rehab Specialist PRN opening. Our team will promptly review your application. Highly qualified ... support our colleagues in their positions. Join our Team as a(an) Clinical Rehab Specialist PRN and access programs to assist with every stage of your career.… more
- Alameda Health System (San Leandro, CA)
- …specific clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post ... SLH Care Management Specialist + San Leandro, CA + San Leandro...key point of contact between clinical case management staff, admissions and payors. Documents all interactions with payors and… more
- UNC Health Care (Goldsboro, NC)
- …accounts that require attention to Pre-Arrival Team Lead/Manager. 7. Notify Utilization Review & Case Management regarding any admissions that need Clinical ... **Description** Summary: The Pre- Arrival Authorization Specialist I will serve patients/customers and physician offices by obtaining authorizations from insurance… more
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