- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …flexibility in scheduling, including evenings and weekends, to address pharmacy-related denials + Educates physician reviewers and clinical review staff ... **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical directors/physician reviewers, network physicians, and network facilities… more
- UNC Health Care (Kinston, NC)
- …to support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying ... the team in the strategy to appeal all clinical denials . Provides the clinical expertise to draft the first...a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… 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
- 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 ... This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to...Guidelines required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care… more
- Datavant (Nashville, TN)
- …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials ...letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +… more
- CommonSpirit Health (Centennial, CO)
- …as a Registered Nurse . 3 years with progressive experience in utilization review , preferred. Prior experience writing clinical denial appeal letters ... indicated through research and coordination of completion of medical records and utilization review processes. Identifies areas for documentation and/or process… 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 ... this position is able to cover a multitude of utilization review functions through point of entry,...point of entry, observation progression of care management, concurrent review and denials reviews. Additionally, the URSN… more
- CDPHP (Latham, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... determinations and appropriate exceptions, coordinating with Medical Directors on denials . In addition, the UR nurse is...of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization… more
- Cognizant (Annapolis, MD)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience in… more
- Beth Israel Lahey Health (Plymouth, MA)
- …care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- 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 ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… 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
- TEKsystems (Canoga Park, CA)
- …This role is ideal for a Licensed Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong ... provider and member claims for accuracy and compliance + Review and process claims in accordance with UM guidelines...activities + Participate in special projects related to claim denials and appeals Required Qualifications: + Active LVN or… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... the supervisor including but not limited to processing concurrent denials . + Preferred experience includes Critical Care or Emergency...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- Dignity Health (Rancho Cordova, CA)
- …work from home within the Greater Sacramento, CA region.** **Position Summary:** The Utilization Review (UR) LVN uses clinical judgement in providing ... assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review . Responsibilities may...the cases. - Watches for follow up and processes denials as indicated, demonstrating wording at 8th grade level,… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- UNC Health Care (Smithfield, NC)
- …episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance with… 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
