- Henry Ford Health System (Troy, MI)
- The support specialist is a support role crucial to the centralized Utilization Review team for time sensitive authorization tracking and resolution ... Additional Information + Organization: Corporate Services + Department: Central Utilization Mgt + Shift: Day Job + Union Code:...team members is our priority. That's why we offer support in the various components of our team's well-being:… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is ... responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD)… more
- TEKsystems (Los Angeles, CA)
- …Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong understanding of HMO/Medicare claims processes. ... + Audit denied provider and member claims for accuracy and compliance + Review and process claims in accordance with UM guidelines and regulatory standards +… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose....net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,… more
- Penn Medicine (Lancaster, PA)
- …Medicine Lancaster General Health is looking for an experienced RN to join our Utilization Management Specialist team! In this critical role, you'll advocate for ... thrive under pressure, we'd love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible for evaluating medical… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
- St. Peters Health (Helena, MT)
- The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN supports the UR RN Coordinator and other UR team members in ... providing all identified utilization review functions for the organization to...14. Collaborates with admitting physician, ED physicians, Hospitalists, Documentation Specialist , and other ancillary staff to assist with the… more
- UnityPoint Health (Cedar Rapids, IA)
- …174223 Overview This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments ... care, optimal clinical outcomes and patient and provider satisfaction. The UM Specialist provides the Utilization Management function for patients admitted to… more
- Community Health Systems (Franklin, TN)
- …to secure timely authorizations and reduce potential denials, utilizing input from the Utilization Review Clinical Specialist . + Monitors and updates case ... **Job Summary** The Utilization Review Coordinator ensures efficient and...documentation and process adherence. + Ability to train and support team members, fostering a collaborative and productive environment.… more
- BayCare Health System (Tampa, FL)
- …a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + ... services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- UNC Health Care (Kinston, NC)
- … the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established ... dollars and appeal win rates. 12. Assists in documentation review in the clinical documentation specialist role...experience as a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
- Katmai (Usaf Academy, CO)
- …need for inpatient/outpatient precertification. **ESSENTIAL DUTIES & RESPONSIBILITIES** + Review precertification requests for medical necessity, referring to the ... Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part of the UMRN program, conduct ongoing… more
- MyFlorida (Tallahassee, FL)
- OPERATIONS REVIEW SPECIALIST - 60046106 Date: Jan 6, 2026 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 867714 Agency: Children and Families Working Title: OPERATIONS REVIEW SPECIALIST - 60046106 Pay Plan: Career Service Position Number:… more
- SUNY Upstate Medical University (Syracuse, NY)
- …including PC, Windows, Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, ... Job Summary: The UR-CR Specialist I is primarily responsible for ensuring that...reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria… more
- Southwest Power Pool (Little Rock, AR)
- …location will all be considered during the hiring process. Facilities Technical Support Specialist II| Pay Range: $64,060.00 - $78,460.00 **"Elevate Your ... Art of Audio/Visual Excellence and Technical Innovation!"** **As our Facilities Technical Support Specialist II, you will:** Primarily be responsible for… more
- UPMC (Bridgeville, PA)
- UPMC Rx Partners is looking for a full time Pharmacy Clinical Review Specialist to join their dedicated team! This position provides prescription data entry and ... Rx Partners Skilled nursing and Hospice clients. The clinical review specialist at Rx Partners works hand...Interface with other departments and identify medical documentation in support of prior authorization requests. + Act as a… more
- University of Colorado (Aurora, CO)
- **Temporary GME Software Support Specialist ** **Description** **University of Colorado Anschutz Medical Campus** **Department:** **Office of Medical Education | ... Graduate Medical Education** **Job Title: Temporary** **GME Software Support Specialist ** **This is a Temporary position limited to no more than 9-months** **Job… more
- St. Luke's Health System (Twin Falls, ID)
- …Luke's is truly a great place to work. We are seeking an Applications Training & Support Specialist to join our Education team in Twin Falls. **What You Can ... clinical and non-clinical Epic EHR workflow to teach and support end users + Opportunity for career growth and...**Responsibilities** + Serves as an initial escalation point for review of system enhancement requests impacting a single application… more
- Immigration and Customs Enforcement (Washington, DC)
- …the IHSC Nursing Services Unit team, they will assist with participating in the development/ review of: i. Special projects to support the DAD of Clinical ... the IHSC Medical Quality Management Unit. SUPERVISORY CONTROLS: The Clinical Senior Nurse Specialist , Medical Asset Support Team (MAST) member works under the… more
- Battelle Memorial Institute (Norfolk, VA)
- …business line is seeking a highly motivated, full-time **Senior Strength and Conditioning Specialist ** to join our team in support of our government customer, ... strengthens both the Forces and their families, ensuring comprehensive support for those who serve. As a Senior Strength...those who serve. As a Senior Strength and Conditioning Specialist , you will contribute to impactful research and analytics… more