- Novo Nordisk Inc. (Providence, RI)
- …appropriate patients that would benefit in order to ensure early trial and utilization Generates advocacy for Novo Nordisk products and services by sharing approved ... by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Qualifications Bachelor's or equivalent degree, and/or Pharm… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team. The Utilization ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… 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 ... Supervisor, supporting the agency's mission and client care quality. Department Utilization Review Employment Type Full-Time Minimum Experience Mid-level… more
- Baylor Scott & White Health (Dallas, TX)
- …Note: Benefits may vary based on position type and/or level **Job Summary** Utilization Review Specialist conducts reviews and shares knowledge with ... staff. Works closely with Medical Director and Health Services leadership. Manages utilization and formulates policies. The role is integral in navigating healthcare… more
- Hunterdon Health Care System (Flemington, NJ)
- Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure the effective and efficient ... an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is ... responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD)… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Reno Behavioral Healthcare Hospital (Reno, NV)
- The UR Specialist reviews and monitors patients' utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties ... include providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency...of care that may be covered. + Monitors all utilization reports to assure compliance with reporting and turnaround… more
- Nuvance Health (Danbury, CT)
- *Description* Summary: The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary team, and organization with the underlying ... of care and providing timely and accurate clinical information to payors. Utilization management provides clinically based first level medical necessity reviews by… more
- Sutter Health (Berkeley, CA)
- …with hospital administration, medical staff, patient registration and representatives of review organizations and others to ensure effective utilization of ... to justify acute hospital admission, need for continued stay, and proper utilization of physician, nursing, and ancillary services. Responsible for concurrent … 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 ... patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! As our … more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services ... and collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital … more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... Knowledge, Skills & Abilities (must have): * Expertise in managing utilization review processes including prior authorization, concurrent and retrospective… more
- Baylor Scott & White Health (Dallas, TX)
- …Note: Benefits may vary based on position type and/or level **Job Summary** The Utilization Review (UR) Support Specialist performs administrative duties to ... other departments. + Answers and screens phone calls for the Utilization Review department. Routes calls as appropriate within customer service guidelines.… more
- Children's Mercy Kansas City (Kansas City, MO)
- …+ Oversees and directs the work of Nurse Case Managers, Social Workers, and Utilization Review specialist team members and support staff + Analyzes, ... support tools and related software applications and implementations. + Engages in utilization review committee. Qualifications + Master's Degree MSN or Masters… more
- Baystate Health (Springfield, MA)
- …meetings to address treatment objectives. **6.** May collaborate as assigned with utilization review specialist to obtain necessary insurance authorizations ... is responsible for gathering a psychosocial evaluation through interviews and record review and completing a written assessment with case formulation and treatment… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Penn Medicine (Lancaster, PA)
- …day. Are you living your life's work? Summary: + Position Summary: The Utilization Management Specialist - Denials is responsible for evaluating medical records ... without reasonable accommodation to perform the following duties: + Complete chart review and communicate patient status medical needs with insurance companies in… more
- Intermountain Health (Las Vegas, NV)
- …1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims review , quality ... with MG clinicians, Affiliate Network PCPs and Specialists in the community, utilization management, care management, claims, network management, and finance. As the… more
- Ascension Health (Pensacola, FL)
- …process. + Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + ... **Details** + **Department: Utilization Review ** + **Schedule: Full time days** + **Hospital: Ascension Sacred Heart Pensacola** + **Location: Pensacola,… more
