- Hackensack Meridian Health (Hackensack, NJ)
- The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical ... Hackensack University Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Sutter Health (Sacramento, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness ... health care services. The PA will develop expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical… more
- CVS Health (Austin, TX)
- …Qualifications** * Experience with managed care, as a provider and manager of care utilization review or physician advisor experience. **Education** * Active ... program/operational efficiency involving clinical issues * Provide leadership and day-to-day physician oversight for utilization management team, including the… more
- Billings Clinic (Billings, MT)
- …and coordinates care with the RN Care Manager, Social Services Care Manager, Utilization Review RN, Physician Advisor and Care Management Assistant. ... here. About Us Billings Clinic is a community-owned, not-for-profit, Physician -led health system based in Billings with more than...high risk for readmission. * Interfaces effectively with the Utilization Review department to stay current on… more
- Hackensack Meridian Health (Brick, NJ)
- …Engage in the teaching, consulting and advising of the care management and utilization review departments and hospital leadership. + Collaborate with a ... . + Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is **preferred** . + Physician… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE ... see comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're… more
- The County of Los Angeles (Los Angeles, CA)
- …Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician member of the ... UTILIZATION REVIEW NURSE SUPERVISOR II Print...by subordinate supervisors on number and status of reviews, physician advisor referrals, and type of physician … more
- Commonwealth Care Alliance (Boston, MA)
- …Group **Position Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director ... our rapidly growing membership. The incumbent will have significant experience with utilization review , ideally experience with public programming, and excellent… more
- AdventHealth (Glendale Heights, IL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use...the UM nurse is responsible for escalation to the Physician Advisor or designated leader for additional review… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... determinations + Recent work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare, Medicaid, and Managed… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review Full Time Days -...based on Medical Necessity and submits case for Secondary Physician review per Tenet policy Ensures timely ... care and appropriate level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as needed. (5% daily,… more
- UPMC (Pittsburgh, PA)
- The Regional Medical Director, CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. This role ... between managed care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote adherence to URAC… more
- Nuvance Health (Danbury, CT)
- …any issues/denials to department leadership.* 12) Forwards reviews that require secondary physician review to appropriate resource ( Physician Advisor) 13) ... one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the physician...required. Education: ASSOCIATE'S LVL DGRE Required: 3 Years of Utilization Review experience(or a certification ACMA, MCG,… more
- Bon Secours Mercy Health (Batavia, OH)
- …are recognized for clinical and operational excellence. **Mercy Health Clermont Hospital** ** Utilization Review and Case Management for Adult Psychiatry Unit** ... responsibility is assumed within the context of appropriate allocation and utilization of resources and quality of care, collaborating with professional hospital… more
- Baptist Memorial (Meridian, MS)
- Overview RN Utilization Review Weekender Job Code: 22818 FLSA Status Job Family: NURSING Job Description Title: RN Utilization Review Weekender Job ... appropriateness of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works...necessity or other areas when indicated + Communicates with physician advisors related to status concerns or denials +… more
- Beth Israel Lahey Health (Plymouth, MA)
- …and identifies trends/root causes of denials for discussion with the internal team, physician advisor and the Utilization Review Committee as appropriate. ... you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We Are:** At… more
- Catholic Health Initiatives (Omaha, NE)
- …2 hours of a Commonspirit Health Facility Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact patient ... 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 Purpose of Position and Scope of Responsibility Job Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and ... appropriateness of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works...necessity or other areas when indicated * Communicates with physician advisors related to status concerns or denials *… more
- AmeriHealth Caritas (Newark, DE)
- …for approval or denial decisions. + Identify and escalate complex cases requiring physician review or additional intervention. + Ensure compliance with Medicaid ... efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- Amergis (Canton, MA)
- …to provide data collection and related activities for Quality Improvement (QI) and Utilization Review as well as completion of financial documents needed for ... be adding Admissions and Insurance Authorizations. MUST have experience with Utilization Review , Authorizations and Admissions. Position Details: + Location:… more