- AdventHealth (Maitland, FL)
- …as assigned by the Division CFO/SrVP, Vice President of Revenue Cycle Operations and/or Director , Utilization Review Management ..Reviews data and trends ... review of long stay patients, in conjunction with the Director of Utilization Review Management to facilitate the use of the most appropriate level of… more
- UCLA Health (Los Angeles, CA)
- …communication is provided to all stakeholders. + Working closely with medical director , utilization management and quality review team to ensure that all ... Description As the Utilization Management & Quality Review Specialist, you will be responsible for: + Managing service requests and potential quality issue… more
- Henry Ford Health System (Detroit, MI)
- The Medical Director of Utilization Review is responsible for the medical oversight of activities related to appropriateness of Henry Ford Hospital (HFH) ... hospital resources, and continued stays of inpatients. The Medical Director of utilization review will...Ensure correct patient status for hospitalized patients 3. Chair Utilization Management Committee: a. Reviewing outlier data,… more
- CareFirst (Baltimore, MD)
- …location based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the ... Hire Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience. **Preferred Qualifications:** +… more
- Ascension Health (Nashville, TN)
- …to Ascension Saint Thomas hospitals throughout the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this ... **Details** + **Department:** Utilization Management + **Schedule:** Monday -...Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured… more
- Trinity Health (Boise, ID)
- …of two years' experience in hospital based medicine with exposure to utilization management and documentation initiatives. 3. Demonstrated teamwork, performance ... MDDUE will work in a dyad partnership with the Director of Clinical Resource Management . This position...patients not meeting inpatient criteria. C. Participates in local Utilization Review Committee and be a member… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according to… more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management ... to the leadership and staff who perform the functions of Utilization Management (UM), Case Management (CM), Transition Planning/ Discharge Planning,… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review , under the supervision and in ... /supervision/leadership experience in an acute healthcare setting required, preferably with case management , utilization review or closely related area. +… more
- Covenant Health Inc. (Louisville, TN)
- Overview Utilization Review Coordinator, Quality Management Full Time, 80 Hours Per Pay Period, Day Shift Peninsula Overview: Peninsula, a division of ... on updated utilization review guidelines. + Participates in Utilization Management Committee. + Performs other related duties as required. Qualifications… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …treatment team, Director of Utilization Management , and the Medical Director . + Review charts at identified review points and attend treatment ... of resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of care and promoting… more
- Behavioral Center of Michigan (Warren, MI)
- Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex ... clinical data and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart and records clinical… more
- Community Health Network (Indianapolis, IN)
- …mission, vision, and values statement. This position is accountable to the Manager/ Director of Utilization Review . **Exceptional Skills and Qualifications** ... + Two years recent clinical experience or three years recent hospital utilization review /case management experience. (Required) **Why Community?** At… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Independent Health (Buffalo, NY)
- …Collaborative and Accountable. **Essential Accountabilities** Provide High Quality, Professional Utilization Management Services: (Medical necessity review ... benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse (URN) performs clinical ...+ Prompt, courteous, professional and error free in performing utilization management functions. + Available to answer… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well… more
- Covenant Health (Nashua, NH)
- …the health care team. + Annual goals are achieved. + Attends pertinent case management / utilization review programs to maintain current knowledge of UR ... Summary Conducts medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed on a nursing unit, to include… more
- SUNY Upstate Medical University (Syracuse, NY)
- … Review Denials Review Unit (DRU) 3 Team Lead will assist the Director of Utilization Review and the Associate Director of Utilization ... and provides feedback/mentorship to UR CR I as to review , payor and regulatory questions. This UR DRU 3...nursing experience required. Minimum of 1 year of denial management experience with progressive proficiency and autonomy of reviews… more
- Hartford HealthCare (Torrington, CT)
- …Inpatient Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the IP ... Psychiatry Patient Care Team to assure Utilization Review activities on a 17 bed...that may include: individual, group, & family therapy; case management , interdisciplinary collaboration for care transition needs, crisis intervention/safety… more
- ERP International (Nellis AFB, NV)
- … Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); Comprehensive Accreditation ... No Call, No Weekends, No Holidays! **Job Specific Position Duties:** * Provides Utilization Management activities and functions by using MTF specific Quality… more