- UCLA Health (Los Angeles, CA)
- …for accuracy, confirming the receipt of necessary documentation to support the denial and ensuring compliance with all contractual obligations and state and federal ... laws/regulations. You will extrapolate and summarize essential information for the UM Manager and Medical Director and regularly meet with them for clinical guidance in resolving cases. You will also document appeals in the tracking system and maintain… more
- Universal Health Services (Doylestown, PA)
- …is a Monday-Friday full-time position offering full-time benefits and competitive pay. The Utilization Management Coordinator is responsible for all ... of medical necessity and timely discharge planning. + Maintains data on utilization management activities and generates required reports, logs, and files… more
- UCLA Health (Los Angeles, CA)
- …Under the direction and supervision of the RN Assistant Director, the Case Management Coordinator is responsible for patient high risk care coordination ... the next level of reviewer in review, and health plan contracts. The Case Management Coordinator will also be responsible for: * Preparation and maintenance of… more
- Universal Health Services (Chicago, IL)
- …continued treatment based on payer's criteria and in accordance with the hospital wide Utilization Management Plan. Serves as liaison to 3rd and 4th party ... physician reviews with payers as required. Maintains all records/data pertaining to the Utilization Management Program. Actively participates in Utilization … more
- Tenet Healthcare (Detroit, MI)
- …for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention Coordinating with ... potentially avoidable days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical and financial requirements and… more
- Banner Health (AZ)
- …you're looking to leverage your abilities - you belong at Banner Health. The utilization Management Representative will process clinicals to send to payers while ... care. POSITION SUMMARY This position assists in the administration of Utilization Management functions to include organization of workflow, communications… more
- Baptist Memorial (Memphis, TN)
- …using evidence based criteria. Areas of work include payer notification, authorization management , denial management , escalations, and communication and ... Summary The Authorization Coordinator is responsible for facilitating information documentation and transmission vital to the effectiveness of utilization review… more
- Apex Health Solutions (Houston, TX)
- …Medical Management Supervisor: UM Supervisor/Manager, Medical Management The Utilization Management Coordinator represents the company by serving as ... Job Title: Coordinator , Utilization Management Department:...Drafting and issuing verbal and written pre-authorization and concurrent approvals/ denial correspondences and notifying providers/enrollees needed. Collaborating with the… more
- Hartford HealthCare (Southington, CT)
- …of Connecticut's most comprehensive healthcare network as a Quality Improvement Coordinator . Hartford HealthCare at Home, the largest provider of homecare services ... corrected billing and chart reviews. **Document patient accounting system with all denial activity and actions taken. **Compile monthly denial reports.… more
- The City of Houston (Houston, TX)
- Senior Business Development Coordinator Print (https://www.governmentjobs.com/careers/houston/jobs/newprint/4484787) Apply Senior Business Development ... OVERVIEW Applications accepted from: ALL PERSONS INTERESTED Division/Section: Terminal Management /Office of Business Opportunities Workdays & Hours*: Monday-Friday, 8:00am… more
- Houston Methodist (Houston, TX)
- …complex patients, receiving coaching from experienced Transplant Coordinators and management , benefiting from their practice. The Pre-Transplant Coordinator ... At Houston Methodist, the Pre-Transplant Coordinator position a registered nurse, responsible for participating in department initiatives, facilitating, and… more
- BrightSpring Health Services (Columbus, OH)
- …Payee to Client Trust Fund* Responsible for working with Client Trust Fund Coordinator at the Austin* Business Center to set up RFMS Account* Assure individuals ... to LON based on submitted/approved IDRCs* Reviews Quickbase for utilization issues requiring IPC revisions in the waiver. Ensures...billing is complete for upload into Quickbase. Sends monthly Denial Reports to operations for any billing denied by… more
- Covenant Health (Lubbock, TX)
- …will work collaboratively with the Social Workers (SW), RN Care Managers (RN-CM), Utilization Review RN's (UR-RN) and Payer Denial Specialists by performing ... representatives. Will work collaboratively with the inpatient and outpatient case management teams to provide evaluation and assessment of patient needs. Duties… more
- Rush University Medical Center (Chicago, IL)
- …managers, community providers, payers and internal/external agencies to provide case management support services related to effective utilization of services ... 8 Hr (9:00:00 AM - 5:30:00 PM) **Summary:** The Clinical resource coordinator (CRC) applies a collaborative approach in working with physicians, patients, case… more
- Highmark Health (Harrisburg, PA)
- …and third party payers. + Maintains a working knowledge of care management , care coordination changes, utilization review changes, authorization changes, ... coordination of care in accordance with recognized standards of practice for Care Management . The incumbent utilizes expertise in care management to promote a… more
- Penn Medicine (Philadelphia, PA)
- … and appeals correspondence. + Maintains database for the department and the utilization management requirements for the hospital information system and within ... communication. + Supports the activities of the Clinical Appeals Coordinator in all phases of the Clinical Quality and... in all phases of the Clinical Quality and Utilization Management functions including but not limited… more
- Actalent (Riverside, CA)
- …for case management scope of services including: Utilization Management supporting medical necessity and denial prevention, Transition Management ... Description: *Responsibilities: Extended Care Coordinator , provide comprehensive case management for...over and underutilization, l) and other duties as assigned Utilization Management : Assures the patient is in… more
- The County of Los Angeles (Los Angeles, CA)
- …methods include group, family, individual and conjoint therapy, clinical case management , and crisis intervention. Positions allocable to this class also provide ... problem, which may include individual, group, family or marital counseling, case management , and/or referral to another treatment source such as a psychiatrist, a… more
- The County of Los Angeles (Los Angeles, CA)
- …problem, which may include individual, group, family or marital counseling, case management , and/or referral to another treatment source such as a psychiatrist, a ... to individuals, groups, families, and significant others. + Provides case management services to secure resources for clients, families and significant others… more
- The County of Los Angeles (Los Angeles, CA)
- …methods include group, family, individual and conjoint therapy, clinical case management , and crisis intervention. Positions allocable to this class also provide ... problem, which may include individual, group, family or marital counseling, case management , and/or referral to another treatment source such as a psychiatrist, a… more