- Rady Children's Hospital San Diego (San Diego, CA)
- …Nursing 4 years nursing in an acute hospital or 2 years Case Management, Utilization Review , or Discharge Planning experience in an acute hospital PREFERRED ... the utilization management process for acute inpatients. Case Managers perform concurrent review and denials management based on acute care guidelines with a… more
- 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
- 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
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the...Performance Tracking and Improvement: Provides analysis and reports of utilization , denials , and appeals KPIs, trends, patterns,… more
- Cedars-Sinai (Los Angeles, CA)
- …Motions, Eye/Hand/Foot Coordination **Req ID** : 14355 **Working Title** : Registered Nurse - Utilization Review Case Manager - 8 Hour Days **Department** ... us one of America's Best Hospitals. Summary of Essential Duties: + The Utilization Management (UM) Registered Nurse - Medicare Short Stay & Concurrent Denials… 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
- 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
- UNC Health Care (Raleigh, 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
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN 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
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review - Case Management - 2506004107 Description : Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse ... level of care, length of stay and authorization Prevents denials and disputes by communicating with payors and documenting...level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as… 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
- UNC Health Care (Hendersonville, NC)
- …the health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge ... in accordance with federal regulations and the health system's Utilization Review Plan. Responsibilities: + Uses approved...patient data and treatments. Communicates daily with the Care Manager to manage level of care transitions & appropriate… more
- Behavioral Center of Michigan (Warren, MI)
- …skills to help educate the staff and physicians regarding charting. REPORTS TO: Utilization Review Lead/ Manager QUALIFICATIONS: + High School Diploma or ... those duties include all tasks requested by the UR Manager , CEO or Medical Director to meet the needs...denials . Responds to complaints per UR guidelines. Maintains utilization review and appeal logs, as needed.… more
- Rochester Regional Health (Rochester, NY)
- …Review standard UM sources for potential inpatient medical necessity denials . Review patient class in the event manager , assist with LOC determination ... 40 hours (Full-Time) Schedule: Monday - Friday, Days SUMMARY: Review all inpatient medical necessity denials for...with minimum direction. + Act as a resource for utilization review stakeholders and assists team members… more
- Baystate Health (Springfield, MA)
- …Minimum - Midpoint - Maximum $46.22 - $53.13 - $62.85 **Per Diem Hospital Case Manager / Utilization Management** The **RN Hospital Case Manager ** is a ... of a designated population of patients. The Hospital Case Manager is responsible for overseeing an efficient plan that...+ Requires a working knowledge of community resources and Utilization /Quality Review standards and activities conducted by… more
- Sanford Health (Rapid City, SD)
- …Schedule:** Full time **Weekly Hours:** 40.00 **Department Details** Join our team as a Utilization Review and Case Management Manager and lead a ... while optimizing value across the care continuum. You'll shape and execute utilization strategies that become the standard for how we coordinate care, authorize… more
- Sharp HealthCare (San Diego, CA)
- …every patient identified per departmental guidelines during hospital stay beginning with the admission review of the case manager and reviews with the Case ... care, SNF, home health, or hospice settings. + Experience as a case manager or discharge planner interacting with managed care payers. + Experience with InterQual… more
- South Middlesex Opportunity Council (Framingham, MA)
- …individuals, children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. ... fashion, for the RRS and outpatient clinic programs. + Review denials and partially paid claims and...As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or incidental contact… 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 ... nursing experience or case management experience. + 3 Years case management, utilization review , care coordination experience. + California Registered Nurse (RN)… more
