- Campbell County Health (Gillette, WY)
- …Coordinator focuses on integrating care management, social services, discharge planning, utilization review and post-hospital services to ensure clinical ... resources. Promotes empowerment of resident in self-management of disease process. * Utilization review of the resident stay is done in a timely manner and… more
- Baptist Memorial Health (Southaven, MS)
- …and/or life situation. Performs other duties as assigned. Responsibilities Utilization Review Discharge planning Readmission Reduction Participation Payer ... safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer… more
- Interim HealthCare Staffing (Huger, SC)
- …practices and equipment use to enhance participant care. Support quality improvement, utilization review , and compliance initiatives. Perform other IDT duties as ... 24-hour care coordination. Supervise Physical Therapy Assistants (PTAs), including review of care plans, co-signing documentation, and providing ongoing mentorship.… more
- HCA HealthONE Rose (Denver, CO)
- …on unit and staff performance issues needing attention. Maintains effective utilization and maintenance of manpower, equipment, and supplies. Other duties as ... for our Clinical Nurse Coordinator Inpatient Surgery opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews.… more
- NHS Management (Birmingham, AL)
- …of subordinate nurses engaged in quality assurance, infection control, and utilization review activities. Receives physicians' instructions regarding resident ... care and ensures that orders are transmitted to other units as needed. Oversees delegation of nursing and other therapeutic procedures to other level professionals and paraprofessional associates. Makes regular patient rounds to observe and assess residents'… more
- NHS Management (Fayetteville, AR)
- …of subordinate nurses engaged in quality assurance, infection control, and utilization review activities. Receives physicians' instructions regarding resident ... care and ensures that orders are transmitted to other units as needed. Oversees delegation of nursing and other therapeutic procedures to other level professionals and paraprofessional associates. Makes regular patient rounds to observe and assess residents'… more
- NHS Management (Madison, AL)
- …of subordinate nurses engaged in quality assurance, infection control, and utilization review activities. Receives physicians' instructions regarding resident ... care and ensures that orders are transmitted to other units as needed. Oversees delegation of nursing and other therapeutic procedures to other level professionals and paraprofessional associates. Makes regular patient rounds to observe and assess residents'… more
- NHS Management (Jacksonville, AL)
- …of subordinate nurses engaged in quality assurance, infection control, and utilization review activities. Receives physicians' instructions regarding resident ... care and ensures that orders are transmitted to other units as needed. Oversees delegation of simple nursing and other therapeutic procedures to other level professionals and paraprofessional associates. Makes regular patient rounds to observe and assess… more
- NHS Management (Athens, AL)
- …care standards through oversight of quality assurance, infection control, and utilization review activities Receive and communicate physician instructions ... related to resident care and ensure orders are implemented appropriately Oversee delegation of nursing and therapeutic procedures within LPN scope of practice Conduct regular resident rounds to assess physical condition, behaviors, and overall care quality… more
- NHS Management (Huntsville, AL)
- …facility policies and procedures Support quality assurance, infection control, and utilization review activities during night operations Receive, communicate, ... and implement physician orders as needed Oversee delegation of nursing and therapeutic procedures to licensed and unlicensed staff Conduct regular patient rounds to assess resident conditions, evaluate quality of care, and ensure accurate documentation Serve… more
- NHS Management (Athens, AL)
- …of subordinate nurses engaged in quality assurance, infection control, and utilization review activities. Receives physicians' instructions regarding resident ... care and ensures that orders are transmitted to other units as needed. Oversees delegation of nursing and other therapeutic procedures to other level professionals and paraprofessional associates. Makes regular patient rounds to observe and assess residents'… more
- NHS Management (Madison, AL)
- …maintaining resident care standards related to quality assurance, infection control, and utilization review Receive and communicate physician orders and ensure ... proper implementation across units Oversee delegation of nursing and therapeutic procedures to licensed and unlicensed staff Conduct regular resident rounds to assess physical conditions, behaviors, and quality of care Ensure accurate documentation of… more
- Unknown (Greensboro, NC)
- …includes overseeing contract negotiations, patient accounting, collections, insurance processes, and the utilization review cycle. The CFO will also manage the ... finance department, oversee employee benefits, and work collaboratively across departments to maintain and enhance the organization's financial health. A key requirement for this role is an MBA in finance, accounting, or business, with a CPA and at least two… more
- AmeriHealth Caritas (Washington, DC)
- …to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... cases are escalated to the Medical Director for further review . The reviewer independently applies medical and...ability to meet productivity standards in a fast-paced, high-volume utilization review environment + Proficiency using MS… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating care for members who ... member's benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer is part of a highly dedicated and motivated team of… more
- Liberty Healthcare Corporation (Salisbury, MD)
- …their best lives. To support this initiative, Liberty is now hiring for a full-time Utilization Reviewer position. As a Utilization Reviewer , your daily ... with developmental disabilities + Service coordination + Case management + Utilization review + Prior authorizations + Claims reviews + Healthcare billing +… more
- Guthrie (Cortland, NY)
- …for those with less than one year of experience) Summary The LPN Utilization Management (UM) Reviewer , in collaboration with Care Coordination, Guthrie Clinic ... Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …as appropriate. At the request of the Senior Medical Director of the Physician Review Unit (PRU), the reviewer also provides clinical leadership in other areas ... transform healthcare? Bring your true colors to blue. The Role The Physician Reviewer is responsible for evaluating pre & post-service clinical service requests made… more
- Healthfirst (NY)
- **Duties/Responsibilities:** + The Medical Peer Reviewer will assess/ review requests for authorization, and claims payment, based on medical records and internal ... and make informed clinical judgments and recommendations. + The Medical Peer Reviewer will render determinations in the format and within timeframes to follow… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas ... your true colors to blue. The Role The Physician Reviewer is responsible for evaluating clinical service requests made...anticipatory case management for members whose cases come for review , in partnership with case managers + Participate in… more
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