- Penn Medicine (Lancaster, PA)
- …you living your life's work? Summary: + Position Summary: The Utilization Management Specialist - Denials is responsible for evaluating medical records ... insurance benefit structures and related legal medical issues. + Knowledge of utilization management and quality improvement processes. + Experience working… more
- St. Luke's University Health Network (Allentown, PA)
- …communities we serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party ... JOB DUTIES AND RESPONSIBILITIES: + Reviews all Inpatient Retroactive Denials in the Denials Management ...+ Prefer minimum of 2-5 years' experience in case management and/or utilization management . +… more
- Trinity Health (Hartford, CT)
- …or with authorization and denial processes + Supports the needs of the Case Management Utilization Coordinator team using data, system reports, and analytics + ... for services. **What you will do** + Responsible for authorization and denials within Case Management ensuring appropriate authorization for inpatient hospital… more
- Baylor Scott & White Health (Dallas, TX)
- …management to provide services to members. + Keep updated on approved utilization management criteria, guidelines, and regulations. **Key Success Factors** + ... use treatment experience and/or behavioral health treatment + Experience with Utilization Management for Substance use treatment experience and/or behavioral… more
- BriteLife Recovery (Englewood, NJ)
- …compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in denials , approvals, and length-of-stay ... What you will be doing? The Utilization Review (UR) Specialist is a...you? + Minimum of 2-3 years of experience in utilization review, case management , or insurance coordination… more
- Spectrum Billing Solutions (Skokie, IL)
- …cycle management company for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team. The Utilization Review ... and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for treatment… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of ... of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary services. Responsible for coordinating and conducting medical… more
- St Joseph's Addiction Treatment & Recovery Centers (Saranac Lake, NY)
- …Centers Location: Inpatient Facility - Saranac Lake, NY Position: Full-time Utilization Review Specialist Shift/schedule: Monday-Friday, 8:00am-4:30pm Pay Range: ... and clinicians to facilitate insurance reviews as needed to address initial denials and appeals. + Prepare and submit written summaries following insurance reviews.… more
- Nuvance Health (Danbury, CT)
- …9am-930pm; including every 3rd weekend rotation Summary: The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary ... of care and providing timely and accurate clinical information to payors. Utilization management provides clinically based first level medical necessity reviews… more
- Catholic Health Initiatives (Omaha, NE)
- **Responsibilities** Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact patient care and optimize ... our patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! As our … more
- Baptist Memorial (Memphis, TN)
- Overview Specialist -Denial Mitigation II RN Job Code: 21432 FLSA Status Job Family: FINANCE Job Summary * Position may be filled in Memphis, TN; Jackson , MS The ... Denial Mitigation-Appeal Specialist II RN serves in a key role of...along to healthcare insurance providers in response to post-claim denials received by BMHCC. Physician Advisor communication may be… more
- Baptist Memorial (Memphis, TN)
- …* The position may be filled in Memphis, TN; Jackson, MS The Denial Mitigation-Appeal Specialist II RN serves in a key role of the BMHCC revenue cycle as ... and denial resolution in order to defend our revenue. The Denial Mitigation-Appeal Specialist II RN reviews the denial received from the payer, completes a thorough… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... **Job Summary** The Clinical Utilization Review Specialist is responsible for...extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key… more
- Trinity Health (Troy, NY)
- …of possible concurrent denials , forwards information to the appropriate Utilization Management /Concurrent Review Nurse within identified process standards * ... Specialist under general supervision, supports the administrative requirements for Utilization Management and works collaboratively with Utilization … more
- Trinity Health (Syracuse, NY)
- …of possible concurrent denials , forwards information to the appropriate Utilization Management /Concurrent Review Nurse within identified process standards * ... Specialist under general supervision, supports the administrative requirements for Utilization Management and works collaboratively with Utilization … more
- Dana-Farber Cancer Institute (Brookline, MA)
- … Specialist is responsible for the comprehensive coordination and management of all prior authorization activities specific to cellular therapy services. ... preferred. + 1 year clinical and/or related experience required. + Case Management , Utilization Review, Oncology, Cellular Therapy and/or Prior Authorization… more
- Penn Medicine (Philadelphia, PA)
- …1500 Market Street Hours: M-F 8a-4:30p, Remote The Health Information Management (HIM) Clinical Documentation Specialist will oversee organization-wide system ... throughout the organization that requires coding and documentation knowledge. Assist Coding Management staff in performing quality audits on coding staff and assist… more
- Access Dubuque (Dubuque, IA)
- Preauthorization Specialist **UnityPoint Health Finley Hospital** 1 Positions ID: 42548515 Posted On 05/14/2025 Refreshed On 06/14/2025 **Job Overview** + **Area of ... **Shift:** 8-5 Monday-Friday + **Job ID:** 165144 **Overview** **Preauthorization Specialist ** **Dubuque, IA** **Monday-Friday 8:00AM-5:00PM** **Full Time Benefits** **Obtains… more
- MaineGeneral Health (Augusta, ME)
- …denial management policies, procedures, and services. + Assists in utilization review, data entry, initiates outside referrals, and communicates with revenue ... Job Summary: MaineGeneral Health is seeking a qualified RN Clinical Appeals Specialist to support our Revenue Cycle team by reviewing denied insurance claims and… more
- Corewell Health (Grand Rapids, MI)
- …across medication access workflows. The MCC team supports medication pre-authorizations, system utilization management , and revenue cycle integrity with a focus ... under insurance plans. Scope of work: The MCC clinical pharmacy specialist will support pharmacy technicians with medication pre-authorization completion through… more