- Sutter Health (Sacramento, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness ... services. The PA will develop expertise on matters regarding physician practice patterns, over- and under- utilization of...excellence in the patient experience. **Job Shift:** Days **Schedule:** Full Time **Days of the Week:** Monday - Friday… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE ... see comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're… 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 ... determinations + Recent work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare, Medicaid, and Managed… more
- The County of Los Angeles (Los Angeles, CA)
- …Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician member of the ... UTILIZATION REVIEW NURSE SUPERVISOR II Print...$177,314.88 Annually Location Los Angeles County, CA Job Type Full time Job Number Y5126D Department HEALTH SERVICES Opening… more
- Commonwealth Care Alliance (Boston, MA)
- …Group **Position Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director ... our rapidly growing membership. The incumbent will have significant experience with utilization review , ideally experience with public programming, and excellent… more
- AdventHealth (Glendale Heights, IL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated leader for additional review as determined by… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review ...+ Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + ... + Req #:41904-31044 + FTE:1 + Posted:May 15, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible for… 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** + ... of InterQual Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of CMS Regulations. **Working… 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
- Baptist Memorial (Meridian, MS)
- Overview RN Utilization Review Weekender Job Code: 22818 FLSA Status Job Family: NURSING Job Description Title: RN Utilization Review Weekender Job ... appropriateness of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works...necessity or other areas when indicated + Communicates with physician advisors related to status concerns or denials +… more
- Beth Israel Lahey Health (Plymouth, MA)
- …you're not just taking a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management ... **Job Type:** Regular **Time Type:** Full time **Work Shift:** Day (United States of...causes of denials for discussion with the internal team, physician advisor and the Utilization Review… more
- AmeriHealth Caritas (Washington, DC)
- …for approval or denial decisions. + Identify and escalate complex cases requiring physician review or additional intervention. + Ensure compliance with Medicaid ... efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- Dignity Health (Mesa, AZ)
- …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the...ensure progression of care. + Engages the second level physician reviewer, internal or external, as indicated to support… more
- Trinity Health (Columbus, OH)
- …technology, financial analysis, audit, provider relations and more. **Position Purpose** RN Utilization Review MCHP is responsible for the coordination of the ... **Employment Type:** Full time **Shift:** **Description:** **Why MediGold?** MediGold (https://medigold.com/)...Sr. Director of Medical Management. + Coordinates with the utilization review , case management, discharge planning staff… 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 ... want to make an impact. HonorHealth offers a diverse benefits portfolio for our full -time and part-time team members designed to help you and your family live your… more
- AmeriHealth Caritas (Philadelphia, PA)
- …and pediatric residential facilities. Upon receipt of a request from a physician for shift care services, the Clinical Care Reviewer contacts the parent/guardian ... necessity of the requested services. The Clinical Care Reviewer may contact the physician to discuss and/or clarify the hours or services requested and may ask… more
- Providence (Napa, CA)
- …Per-Diem **Job Shift:** Day **Career Track:** Clinical Professional **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas St **Work ... (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico,… more
- Beth Israel Lahey Health (Burlington, MA)
- …with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities for ... **Job Type:** Regular **Time Type:** Full time **Work Shift:** Day (United States of...Physician Advisors Works collaboratively managing the process of Utilization Review throughout the system **As a… more
- Covenant Health Inc. (Knoxville, TN)
- …meetings between physicians and payors as applicable. + Completes daily work lists for utilization review meeting the time frames set forth by Covenant Health. + ... Overview Registered Nurse, Revenue Integrity & Utilization Management Full Time, 80 Hours...physician advisors and facility departments as related to utilization management. Communicates with hospital and payor medical directors… more
- UNC Health Care (Raleigh, NC)
- …_We are currently seeking an experienced nurse to join our dynamic team as an RN Utilization Manager. Role is full time, 40 hours per week, on site._ Become part ... to expert surgical services and orthopedic care, Rex Holly Springs Hospital provides a full spectrum of health services to meet the needs of its patients._ _The… more
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