- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role BHPS provides Utilization Review services to its clients. The UM Denials Coordinator supports the Utilization Management function by reviewing ... obtain additional information, or resolve discrepancies prior to letter release. The UM Denials Coordinator reports to the Clinical Services team and… more
- Sharp HealthCare (San Diego, CA)
- …readmissions to acute or visit to the Emergency Department.Informs Director, QI/ UM of any quality issues.Attends hospitalists rounds, as required, to discuss ... benefits and accurately follows Health Plan and/or Medicare Guidelines when issuing denials .Ensures that all denials for medical necessity are issued under… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient ... indicated. + Identify and facilitate resolution of system process problems impeding UM functions. Identify and resolve delays and obstacles as appropriate. +… more
- Tenet Healthcare (Detroit, MI)
- …payors with an authorization process Closes open cases on the incomplete UM Census Completes the Medicare Certification Checklist on applicable admissions Discusses ... support admission, level of care, length of stay and authorization Prevents denials and disputes by communicating with payors and documenting relevant incoming and… more