- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Utilization Review / Quality Assurance Coordinator is responsible for all compliance related paperwork and ensures all compliance ... paperwork is completed in a timely manor for the Upstate/Syracuse City School District school-based mental health care program. This position helps ensure successful visits by DNV and OMH when they occur. Monitors and maintains performance improvement… more
- WMCHealth (Valhalla, NY)
- …hospital or health care agency, one of which must have been in the area of utilization review , quality assurance , risk management or discharge planning. ... the implementation or investigation of the procedures specified in the Quality Management, Utilization Review and Discharge Planning Program at Westchester… more
- Intermountain Health (Las Vegas, NV)
- …medical review activities pertaining to utilization review , claims review , quality assurance , and medical review of complex, controversial, ... timely documentation and reporting. + Demonstrated knowledge of case management, utilization management, quality management, discharge planning, and other cost… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity ... using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity… more
- BAYADA Home Health Care (Orlando, FL)
- …should be available Monday-Friday from 8:30am-5:00pm. _Medicare, Coder, OASIS Review , Utilization Review , Quality Assurance , Remote, Home Health ... Home Health Care is hiring a full time OASIS Review and Coding Manager. The OASIS and Coding ...monitoring Outcome and Assessment Information Set (OASIS) documentation for quality and adherence to policies and procedures. As a… more
- BAYADA Home Health Care (Orlando, FL)
- …with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance , Remote, Home Health Coding, ... Home Health Care has an immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work remotely. RN, PT, OT, and… more
- LifePoint Health (Wilson, NC)
- …Science or related associate healthcare degree OR minimum of 2 years' experience in utilization review / quality assurance work. Registration as an RHIT ... and according to established policies and procedures, performs admission and concurrent review of all patients to determine appropriateness of admission and extended… more
- Beth Israel Lahey Health (Burlington, MA)
- …coordinates utilization review , discharge planning and monitors quality assurance for Lahey Clinic inpatient admissions. Leads the multidisciplinary ... in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient...needed. 10) Supports all service line activities related to utilization and quality management. 11) Assists in… more
- Centene Corporation (Jefferson City, MO)
- … quality improvement activities. + Performs medical review activities pertaining to utilization review , quality assurance , and medical review ... + Provides medical expertise in the operation of approved quality improvement and utilization management programs in...with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends… more
- Marshfield Clinic (Marshfield, WI)
- …**JOB SUMMARY** The Utilization Review Specialist, Revenue Cycle Provide quality assurance of medical care. Perform quality control related to ... the most exciting missions in the world!** **Job Title:** Utilization Review Specialist **Cost Center:** 101651289 Revenue...patient care. + Knowledge of the factors contributing to quality patient care, and the ability to influence these… more
- Stanford Health Care (Palo Alto, CA)
- …case management, including the principles and practices of discharge planning, utilization review , and quality assurance / improvement + Knowledge of the ... responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient… more
- Bon Secours Mercy Health (Toledo, OH)
- …**Work Experience** 3 years' experience in clinical health care patient accounting, admitting, utilization review , quality assurance or case management ... 5 years' experience in clinical health care patient accounting, admitting, utilization review , quality assurance or case management (preferred)… more
- MTC (Bryan, TX)
- …co-dependency, and related disorders. 2. Performs complex technical assistance work; implements quality assurance utilization review procedures; and ... and procedures. 3. Assists in monitoring, reviewing, interpreting, and evaluating quality of services; assists in compiling and analyzing data and preparing… more
- University of Maryland, Baltimore (Baltimore, MD)
- …Directs activities related to the delivery of medical care and clinical services such utilization review , quality assurance , policies, procedures and ... operational, and leadership skills and experience in neonatal care, quality , and safety to lead the clinical service. The...clinical and reimbursement activity. 7. Participates in the Peer Review Program as described in the Medical Staff Bylaws… more
- CenterLight Health System (Flushing, NY)
- …(5+) years of experience in care/case management, disease management, population health management, utilization review , quality assurance , or discharge ... model. + Escalates questions or concerns during the assessment to the quality review team to ensure appropriate completion of UAS-NY and handling of on-site… more
- FlexStaff (New York, NY)
- …(5+) years of experience in care/case management, disease management, population health management, utilization review , quality assurance , or discharge ... delivery model. Escalates questions or concerns during the assessment to the quality review team to ensure appropriate completion of UAS-NY and handling of… more
- Ochsner Health (New Orleans, LA)
- …(ACPA) or (2) Board Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (3) Physician Advisor ... Sub-Specialty Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (4) commitment to apply for such… more
- CVS Health (Hartford, CT)
- …a Medical Director you will focus primarily on overseeing utilization review and quality assurance of inpatient hospitalizations, prior authorizations, ... a part of the rotation. The Medical Director will be responsible for overseeing the utilization review for health systems and providers in New England. An ideal… more
- ManpowerGroup (Columbia, SC)
- …of an Accredited School of Nursing. + 2 years clinical experience plus 1 year in utilization /medical review , quality assurance , or home health. + An ... their team. As an Analyst, Appeals, you will be part of the clinical review department supporting the appeals team. The ideal candidate will have strong analytical… more
- Sevita (Baltimore, MD)
- …members as needed. + May implement crisis intervention emergency procedures, participate in Utilization Review , Quality Assurance and investigations. ... coordinators, + Review treatment plans and clinical notes to ensure quality services are provided for clients; proactively address any client issues with respect… more