- Marion County (Salem, OR)
- …but also have numerous opportunities to engage with and address systems -level challenges. An ideal candidate would be compassionate, highly collaborative, have ... medical conditions. This position is an outward facing position, operates on a systems level and involves coordination with entities on the state and local levels,… more
- Marion County (Salem, OR)
- …and objectives of the programs, to ensure high-quality service delivery.Develop performance management systems and set metric benchmarks to ensure accountability ... opportunities to identify existing strengths and gaps in existing service delivery system .Budget, Contract and Grant Management Provide expertise, oversight and… more
- UT Health Tyler (Tyler, TX)
- …and coordinates a comprehensive plan of care using a concurrent integrated review , standard operating procedures, case management tools, and collaborative ... bigger than your department: UT Health Tyler, the flagship hospital of the system , has 502 licensed beds specializing in advanced acute care medicine. Our hospital… more
- Guthrie (Sayre, PA)
- Position Summary: The Utilization Management (UM) Reviewer , in collaboration with other internal and external offices, payors, and providers and staff, is ... responsible for the coordinates Utilization Management (UM) processes and requirements for...prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures authorization as appropriate… more
- Baptist Memorial (Memphis, TN)
- Summary Responsible for the Utilization Review Program across the system . In collaboration with system care coordination leadership ensures the strategic ... of clinical experience at least 2 of which involve Utilization Review or Case Management ...+ Employee referral program Job Summary: Position: 18373 - System Manager- Utilization Review Facility: BMHCC… more
- CDS Life Transitions (Webster, NY)
- Summary: Utilization Management Reviewer (UR) is the critical evaluation of health care services provided to members using an integrated approach to ... of controlling costs and monitoring quality of care. The Utilization Management Reviewer will play...by supervisor. + Acts as Subject Matter Expert in Utilization Review and medical necessity criteria +… more
- Cleveland Clinic (Stuart, FL)
- …not only an excellent medical facility, but also a home away from home. As a Utilization Management (UM) RN Reviewer , you will work under the general ... review , concurrent review , retrospective chart review and clinical systems review ...a minimum of 85% on IRR quarterly. + Completes Utilization Management for assigned patients with a… more
- Atlantic Health System (Hackettstown, NJ)
- …process, CMS required patient notices and other regulatory requirements within the utilization management process. 10. Maintains proficiency in the application ... for CMS required patient notices. 8. Completes and documents utilization reviews, physician advisor referrals and other communications related...of organization selected clinical review criteria sets evidenced through IRR testing Graduate of… more
- Stanford Health Care (Palo Alto, CA)
- …guidelines and utilization management principles. + Experience in case management , utilization review , or related healthcare roles. + Strong clinical ... onsite Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN) will...ensure the necessity and appropriateness of care provided. 3. Utilization Review : Conduct thorough utilization … more
- Dignity Health (Northridge, CA)
- …400 care centers. Visit dignityhealth.org/northridgehospital for more information. The RN Utilization Management Coordinator (UMC) is responsible for assessing ... and in compliance of the Behavioral Health Dignity Health Utilization Review Policy. + The UMC will...+ Current CA Registered Nurse (RN) license + Prior Utilization Management experience in a clinical or… more
- Sutter Health (Salt Lake City, UT)
- …SHSO-Sutter Health System Office-Valley **Position Overview:** This position facilitates utilization management (UM) processes to support that the right care ... preferred. Working knowledge of laws, regulations and professional standards affecting case management practice in an integrated delivery system : including but… more
- System One (Dayton, OH)
- Clinical Care Reviewer (2 roles are open) ALTA is supporting a contract opportunity working remote located anywhere in the United States The absolutely necessary ... mandatory. MCG certification is preferred, but not necessary Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness… more
- Intermountain Health (Murray, UT)
- …providing physician peer review and clinical direction for SelectHealth including utilization management , case management , appeals, criteria and policy ... care delivered by panel providers. 3. Utilization Management : Assist in the development and review ... management physician reviewer services, including management of scheduling, optimizing review process, and… more
- Prime Therapeutics (Columbus, OH)
- …- Oncology - REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do ... VP, Medical Affairs in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On a… more
- Evolent Health (Columbus, OH)
- …Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On a ... you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent Health (Columbus, OH)
- …Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + Participates ... you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Centers Plan for Healthy Living (Margate, FL)
- …preferably in a managed care environment in related area of responsibility, (ie utilization management , quality management , grievances, and appeals) Type of ... RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063,...requirements including timelines. + Presents recommendations based on clinical review , criteria, and organizational policies + Communicates clearly and… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …medical terminology and experience in the analysis and processing of claims, utilization review , quality assurance procedures, payment methodologies and Part D ... Position Purpose: The Clinical Reviewer will be responsible for conducting clinical reviews...fraud, waste and abuse. Responsibilities: + Perform the clinical review in Standard Claims Processing System files… more
- Medical Mutual of Ohio (OH)
- …consistent and quality health care services. + Keeps up to date on utilization management regulations, policies and practices. + If assigned to Preceptor/Trainer ... 3 years as a Registered Nurse with a combination of clinical and or utilization /case management experience, preferably in the health insurance industry. + Acute… more
- Queen's Health System (Kamuela, HI)
- …and research. * Accountable for the development, organization, and implementation of utilization review (UR) processes in order to achieve efficient cost ... facilitates key clinical performance improvement efforts including, but not limited to: disease management , peer review , quality and risk management focus… more
