- The University of Vermont Health Network (Plattsburgh, NY)
- …Department at Champlain Valley Physicians Hospital (CVPH) in Plattsburgh, NY.GENERAL SUMMARY:The Utilization Review RN monitors, collects and analyzes data and ... overall quality of care based on benchmarked criteria or established practices. The Utilization Review RN in utilizing these skills assists the Medical Center… more
- Wellstar Health System, Inc. (Decatur, GA)
- …is expected that the individual upholds the voice of the patient, system policies and procedures while supporting service excellence goals. Responsibilities Core ... to diverse and inclusive interdisciplinary communication methods (interdisciplinary rounds, case review , etc); completion of timely documentation and promotion of a… more
- Wellstar Health System, Inc. (Avondale Estates, GA)
- …that the individual upholds the voice of the patient, system policies and procedures while supporting service excellence goals.ResponsibilitiesCore Responsibilites ... to diverse and inclusive interdisciplinary communication methods (interdisciplinary rounds, case review , etc); completion of timely documentation and promotion of a… more
- University of New Mexico - Hospitals (Algodones, NM)
- This is a Utilization Review position. We review all admissions and continued stay to the hospital for Medical necessity and manage the insurance ... authorization throughout the stay . Department: Utilization Management - UH FTE: 0.05 Casual...responses to interventions in collaboration with quality assurance and utilization review , maintaining interdependent follow-up as necessary… more
- Honeywell (Phoenix, AZ)
- …organization responds to issues globally and across all aerospace products and systems . All team members provide their support for customer satisfaction and added ... value to Honeywell by ensuring that the required customer, product, and system support exists for timely issue resolution. What Are We Looking For? An exciting… more
- Tower Water (Somerset, NJ)
- …Leverage technology and tools to streamline sales processes. Implement a customer relationship management (CRM) system for efficient tracking and management ... Tower Water Management is seeking an experienced Water Treatment Sales...Systems , prepare written proposals w/recommendations for improvement. -- Utilization of Value Selling approach -- Selling Service contracts… more
- ChristianaCare (Wilmington, DE)
- …plan. Social Worker resolve psycho-social barriers and support discharge needs. Utilization Management reviews patient status for appropriateness and anticipated ... Certification (CCM) required within 18 months of eligibility. Complete 8 continuing education credits (CEU) per year in Utilization and/or Case Management more
- University of New Mexico - Hospitals (Algodones, NM)
- …patient responses to interventions in collaboration with quality assurance and utilization review , maintaining interdependent follow-up as necessary * VARIANCE ... management interventions by utilizing established procedures including census review , risk screens, and referral * SUPERVISION - Develop efficient organizational… more
- Guthrie (Sayre, PA)
- Position Summary: The Utilization Management (UM) Reviewer , in collaboration with other internal and external offices, payors, and providers and staff, is ... responsible for the coordinates Utilization Management (UM) processes and requirements for...prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures authorization as appropriate… more
- Baptist Memorial (Memphis, TN)
- Summary Responsible for the Utilization Review Program across the system . In collaboration with system care coordination leadership ensures the strategic ... of clinical experience at least 2 of which involve Utilization Review or Case Management ...+ Employee referral program Job Summary: Position: 18373 - System Manager- Utilization Review Facility: BMHCC… more
- Sharp HealthCare (San Diego, CA)
- …time for routine, urgent and expedited referrals as outlined in SCMG's Utilization Management Plan.Decisions will be communicated to the appropriate persons ... + Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, established criteria such as… more
- Universal Health Services (Memphis, TN)
- …and advocates for patient length of stay and level of care. Oversees utilization review activities with other departments to ensure reimbursement for services ... Responsibilities Lakeside Behavioral Health System provides an excellent opportunity for those seeking...treatment team member or 5-7 years of experience in utilization management for both mental health and… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …safe discharge coverage for all hospital units. + Participates in utilization management initiatives/opportunities for improvement through departmental committee ... Florida. + 3 years minimum experience in discharge planning, utilization management , or case management ....with electronic medical records, and/or discharge planning and case management systems . + Able to maintain confidentiality… more
- Sharp HealthCare (San Diego, CA)
- …is appropriate for the referral request being reviewed.Document in the referral management system , according to SCMG operational processes, actions taken on ... the appropriateness of service/care.Attach corresponding documents to the referral within the referral management system in OnBase, the document management … more
- Dignity Health (Northridge, CA)
- …400 care centers. Visit dignityhealth.org/northridgehospital for more information. The RN Utilization Management Coordinator (UMC) is responsible for assessing ... and in compliance of the Behavioral Health Dignity Health Utilization Review Policy. + The UMC will...+ Current CA Registered Nurse (RN) license + Prior Utilization Management experience in a clinical or… more
- Magellan Health Services (Evanston, WY)
- Assists in processing difficult behavioral case management utilization requests in a timely manner according to company guidelines using current knowledge of the ... resource to local agencies for current behavioral health care management systems . + Attends meetings related to...to ensure accurate documentation and reporting. + May process utilization review requests received by phone, fax… more
- Evolent Health (Columbus, OH)
- …Reviewer , Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Prime Therapeutics (Columbus, OH)
- …- Oncology - REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do ... VP, Medical Affairs in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On a… more
- Evolent Health (Columbus, OH)
- …Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + Participates ... , you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Centers Plan for Healthy Living (Margate, FL)
- …preferably in a managed care environment in related area of responsibility, (ie utilization management , quality management , grievances, and appeals) Type of ... RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063,...requirements including timelines. + Presents recommendations based on clinical review , criteria, and organizational policies + Communicates clearly and… more
