- AdventHealth (Maitland, FL)
- …as assigned by the Division CFO/SrVP, Vice President of Revenue Cycle Operations and/or Director , Utilization Review Management ..Reviews data and trends ... review of long stay patients, in conjunction with the Director of Utilization Review Management to facilitate the use of the most appropriate level of… more
- St. Luke's University Health Network (Allentown, PA)
- …registrations and/or physician queries + Serves as liaison between Physician Advisor/Medical Director , Finance, Utilization Review Department and CDCI. ... Conducts reviews of cases lost with feedback to respective departments + Conduct concurrent review with utilization review department for post op surgical… more
- UTMB Health (Galveston, TX)
- Utilization Review Case Mgr. - Galv. Campus Utilization Mgmt . (M- F / 8a- 5p) **Galveston, Texas, United States** **New** Nursing & Care Management ... and reports trends of inappropriate resource utilization to Director /Assistant Director of Utilization Management . + Maintains a documentation system… more
- BrightSpring Health Services (San Antonio, TX)
- …days of death and submit to State Health Services Director and Assigned Director , Clinical Practice* Review utilization report at least monthly to ensure ... are coordinated with behavioral and programmatic staff in partnership with the Executive Director . The Director of Nursing is accountable for overseeing the… more
- MTA (Staten Island, NY)
- Asst Trans Mgmt Analyst 2 Job ID: 7524 Business Unit: SIRTOA Location: Staten Island, NY, United States Regular/Temporary: Regular Department: Transportation Date ... Posted: Aug 2, 2024 Description Job Information: Title: Transit Management Analyst Series First Date of Posting: 06/10/2024 Last Date of Filing: 06/24/2024… more
- Point32Health (Canton, MA)
- …leading, and modifying the business processes and operations for all levels of utilization management review (ie, Precertification and Intake Services, ... who we are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director , Utilization Management is responsible for directing,… more
- WellSpan Health (York, PA)
- … Management Review Committees. Co-chair's System Utilization Management Committee. + Works closely with Medical Director to identify trends in ... + Organizes and assists Medical Director with System Utilization Management Committee (URC) meetings. Prepares reports for review at the URC meeting.… more
- Catholic Health Initiatives (Lexington, KY)
- …can happen both inside our hospitals and out in the community. **Responsibilities** The Utilization Management (UM) Director is responsible for the market(s) ... processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops...medical staff on issues related to utilization management . 8. Implements utilization review … more
- CareFirst (Baltimore, MD)
- …location based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the ... Hire Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience. **Preferred Qualifications:** +… more
- Trinity Health (Boise, ID)
- …of two years' experience in hospital based medicine with exposure to utilization management and documentation initiatives. 3. Demonstrated teamwork, performance ... MDDUE will work in a dyad partnership with the Director of Clinical Resource Management . This position...patients not meeting inpatient criteria. C. Participates in local Utilization Review Committee and be a member… more
- Arms Acres (Bronx, NY)
- …life skills) as identified in patient treatment plans and requested by program director . Performs utilization review , provides progress reports and develop ... drugs. Sign-on bonus eligible FUNCTION: To provide comprehensive clinical case management services that include: assessments; individual, group and family treatment;… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according to… more
- Dignity Health (Bakersfield, CA)
- …practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment, ... decision making in the areas of: prior authorization, concurrent review of hospitalized patients, discharge planning management ....Minimum of 10 years+ of clinical experience in a Utilization Management setting preferred - Board Certified… more
- The Cigna Group (Bloomfield, CT)
- …Business Title: Medical Director , Durable Medical Equipment Cigna Title: Utilization Review Medical Principal II. Department Name and Number: Product ... Clinical Management 2500 III. Reports to: Executive Medical Director...necessity requests for clinical services that do not meet utilization review criteria and renders a clinical… more
- Trinity Health (Silver Spring, MD)
- …the activities of RN Case Managers for in inpatient care coordination and utilization review . Oversees interactions of staff with outside activities and agencies ... required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At...in an acute healthcare setting. + Designation Changes and Utilization Review + Knowledge of pertinent regulatory,… more
- Arms Acres (Carmel, NY)
- …life skills) as identified in patient treatment plans and requested by program director + Performs utilization review , provides progress reports and ... NY. In this role, you will provide comprehensive clinical case management services that include: assessments, individual, group and family treatment, treatment… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …treatment team, Director of Utilization Management , and the Medical Director . + Review charts at identified review points and attend treatment ... of resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of care and promoting… more
- Billings Clinic (Billings, MT)
- …Starting Wage DOE: $35.34 - 44.18 Under the direction of department leadership, the Utilization Review / Management RN. This position is to conduct initial, ... prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings Clinic (Billings Clinic… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well… more