- Community Health Systems (Franklin, TN)
- **Job Summary** The Part-Time 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
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry ... duties of the URN, this position is able to cover a multitude of utilization review functions through point of entry, observation progression of care management,… more
- Westborough Behavioral Healthcare Hospital (Westborough, MA)
- …for a UR Specialist to provide Per Diem coverage. Job Description: The Utilization Review Specialist is responsible for monitoring adherence to the ... hospital's utilization review plan to ensure the effective...use of hospital services. Monitors the appropriateness of hospital admissions and extended hospitals stays. Completing data collection of… more
- Hunterdon Health Care System (Flemington, NJ)
- This is an in-person role. Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure ... efficient use of hospital services and monitors the appropriateness of hospital admissions and extended hospital stays. The evaluation of the appropriateness and… 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
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- CaroMont Health (Gastonia, NC)
- …RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal ... Job Summary: Completes initial review for medical necessity for all admissions...NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case… 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
- AdventHealth (Orlando, FL)
- …Services in the verification process. Obtains pre-authorization and provides information to the Utilization Review Specialist , Utilization Review ... are not limited to: plan, prioritize, organize, direct and control all admissions and transfers between hospitals, departments and/or nursing units for AdventHealth.… 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
- Sanford Health (Sioux Falls, SD)
- …level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to assure ... relating to determination of medical necessity, authorization, continued stay review including diagnosis and procedural coding for working diagnosis related… more
- Penn State Health (Hershey, PA)
- …an admission to the facility, and for concurrent/continued stay review as appropriate. Also responsible for maintaining compliance with the CMS Conditions ... outlaw discrimination._ **Union:** SEIU Healthcare Pennsylvania **Position** RN Registered Nurse Utilization Management Specialist - Utilization Management… more
- New York State Civil Service (Albany, NY)
- …reviews before an applicant's admission to an RTF. The Teams also review applicants and current RTF admissions to determine if the individuals meet ... continued OMH Medicaid District 97 coverage during an RTF admission . The Mental Health Program Specialist 2/RTF...in a clinical capacity, as well as experience with utilization management and/or utilization review .… more
- HCA Healthcare (Dallas, TX)
- …acute inpatient rehabilitation services prior to returning home. The Clinical Rehabilitation Specialist will review these patients daily until they have strong ... Specialist will assist and coordinate the in-take and pre- admission screening process. The Clinical Rehabilitation Specialist accurately documents… 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 (Kissimmee, FL)
- …personal growth, we encourage you to apply for our Clinical Inpatient Rehab Specialist opening. We promptly review all applications. Highly qualified candidates ... care like family! Jump-start your career as a(an) Clinical Inpatient Rehab Specialist today with HCA Florida Osceola Hospital. **Benefits** HCA Florida Osceola… 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
- 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
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