- 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 ... RN Case Manager **Position Summary** At Stony Brook Medicine, a...cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to… more
- Beth Israel Lahey Health (Plymouth, MA)
- …you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding UR… more
- Beth Israel Lahey Health (Plymouth, MA)
- …is expanding its **Care Transitions Department** and seeking an experienced ** Manager of Utilization Review & Denials Management** and ** Utilization ... or other case management certification preferred or in progress ** Manager - Utilization Review & Denials Management** This role is ideal for a Manager… more
- Hartford HealthCare (Farmington, CT)
- …practices. *_Position Responsibilities:_* *Key Areas of Responsibility* *Denial Resolution* . Review DRG validation denials from payers, analyze the denial ... The Denial Specialist 2 is responsible for reviewing, analyzing, and appealing denials related to DRG (Diagnostic Related Group) validation denials . This… 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 ... respond to all concurrent and post-discharge third party payer denials of outpatient and inpatient cases alleged to be...required or completed within three years of hire **Title:** * Manager - Utilization Review * **Location:**… more
- Community Health Systems (Franklin, TN)
- …Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals activities. ... timely authorizations and reduce potential denials , utilizing input from the Utilization Review Clinical Specialist. + Monitors and updates case management… 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 entry and ... this position is able to cover a multitude of utilization review functions through point of entry,...plan of care and ensures prompt notification of any denials to the appropriate case manager , … 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
- 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
- Dignity Health (Sacramento, CA)
- **Job Summary and Responsibilities** The ** Utilization Review RN** is responsible for the review of medical records for appropriate admission status and ... Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies + Collaborates with...admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the… 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 ... care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management… more
- UNC Health Care (Smithfield, NC)
- …care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management ... needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in… 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
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… 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 ... the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established… more
- Henry Ford Health System (Troy, MI)
- GENERAL SUMMARY: Under the direction of the Utilization team manager to provide administrative, operational, and organizational support for the Utilization ... systems that affect payment of the claim, network assignment discrepancies, reversing payment denials and tracking of referral benefits. + Provides direct and day to… more
- Beth Israel Lahey Health (Beverly, MA)
- …the data as it relates to denials and reports that data to the Manager of Case Management for review . The Clinical Denials Specialist utilizes nursing ... denials specialist coordinates with the Physician Advisor retroactive and concurrent denials . This position reports directly to the Manager of Case… more
- Houston Methodist (Katy, TX)
- …Audit, Business Practices, Health Information Management, Patient Access Services, and Utilization Review as needed to ensure operational billing compliance ... At Houston Methodist, the Manager Revenue Cycle position is responsible for the...to: medical coding, insurance billing, collections, patient account resolution, appeals/ denials , customer service, cash applications, revenue integrity, etc. This… more
- Sharp HealthCare (San Diego, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... medical record and provides information to the department head as indicated. + Utilization review and utilization managementThe RN CM I will:Conduct… more
- Whidbey General Hospital (Coupeville, WA)
- …experience and background to assure compliance with CMS Conditions of Participation regarding Utilization Review and Discharge Planning. The RN - Care Manager ... hospital's Case Management/ Utilization Plan that integrates the functions of utilization review , discharge planning, and resource management into a singular… more
