- 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) ... utilization of hospital resources, and continued stays of inpatients. The Medical Director of utilization review will ensure the most efficient use of the… more
- CaroMont Health (Gastonia, NC)
- …MCO, Medicare, or RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of ... medical necessity will be performed and documented in medical review , including daily status update while...NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case… more
- Trinity Health (Springfield, MA)
- …Type:** Part time **Shift:** Rotating Shift **Description:** Requires BSN At **Mercy Medical Center** the ** Utilization Review /Appeals & Denials** **RN** ... and their families. **What you will do** + Perform utilization review and payer notification + Establish...Option A, 4 Shifts a month** **Ministry/Facility Information** **Mercy Medical Center** has established itself as one of the… more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management ... consultation to the leadership and staff who perform the functions of Utilization Management (UM), Case Management (CM), Transition Planning/ Discharge Planning, and… more
- Spectrum Billing Solutions (Skokie, IL)
- …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing...want to promote within our team. + Benefits - Medical , Dental, Vision + Flexible Paid Time Off -… more
- St. Luke's University Health Network (Allentown, PA)
- …incorrect registrations and/or physician queries + Serves as liaison between Physician Advisor/ Medical Director, Finance, Utilization Review Department and ... Conducts reviews of cases lost with feedback to respective departments + Conduct concurrent review with utilization review department for post op surgical… more
- The Cigna Group (Bloomfield, CT)
- …Must be able to research clinical issues on internet resources. - Experience in medical management, utilization review and case management in a managed ... medical research to ensure the quality of the medical care provided to patients. Implements utilization ... trends. Requires an MD or DO. SUMMARY: The Medical Principal performs medical necessity review… more
- Beth Israel Lahey Health (Burlington, MA)
- …a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in Burlington Hospital ... hospital staffs. -Case Manager experience as well as Utilization Review experience ( review medical necessity and discharge planning) **As a health care… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …identified concerns to the treatment team, Director of Utilization Management, and the Medical Director. + Review charts at identified review points and ... 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
- Medical Mutual of Ohio (OH)
- …in a healthcare environment.** **Technical Skills and Knowledge** + Knowledge of medical terminology, utilization review processes and awareness of ... Founded in 1934, Medical Mutual is the oldest and one of...general supervision,** **performs administrative functions in support of assigned utilization review or case management department. Receives… more
- Lancaster General Health (Lancaster, PA)
- …to clinical services provided by the Hospitalists, quality improvement, education of staff, medical and utilization review and feedback, and support for ... **Summary** **Job Description** **POSITION SUMMARY:** The Associate Medical Director, Hospitalist Services is responsible for assisting the Medical Director,… more
- Cleveland Clinic (Vero Beach, FL)
- …Some of the responsibilities of a Utilization Management Specialist include medical record review , providing clinical information to payers, UM data ... affect reimbursement for the patient's hospital stay or visit. Responsibilities include medical record review , providing clinical information to the payer, UM… more
- The Cigna Group (Bloomfield, CT)
- …by a supervisor in Utilization Management. Handles moderately complex medical review , utilization review , credentialing/re-credentialing, quality ... appropriate course of action for treatment. May analyze treatment patterns and utilization trends. Contributes to the development and implementation of action plans… more
- Banner Health (Phoenix, AZ)
- …will provide guidance and cultivate efficiency related to patient care delivery and provide medical case review , utilization , and quality review , plus ... clinical staff, fostering an environment of quality care and efficiency. + Conduct medical case reviews, utilization and quality assessments, and make strategic… more
- US Tech Solutions (Columbia, SC)
- …practices. + May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews ... level. If not, then it would be sent for review with our medical director. We would...indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization… more
- SUNY Upstate Medical University (Syracuse, NY)
- …patients, maintaining accurate attendance and therapy records. Interfaces with nursing, medical staff, utilization review social services, discharge ... progress through written and verbal reports and through documentation in the medical record. Plan and schedule patient therapy based on individual needs. Schedules… more
- G-TECH Services, Inc. (Detroit, MI)
- …Skills/Experience - Optional but preferred skills/experience. Include: * Utilization Review experience at a previous insurance company ( medical , surgical ... which may include acute patient care, discharge planning, case management, and utilization review with another insurance provider, etc. Demonstrates clinical… more
- CareFirst (Baltimore, MD)
- … medical -surgical or similar clinical experience OR + 5 years experience in Medical Review , Utilization Management or Case Management at CareFirst ... resolution of appeals and reconsiderations, including Regulatory complaints and External review requests. Accountable for quality review and interpretation of… more
- Sharp HealthCare (San Diego, CA)
- …all accounts in rep assignment or alpha split. Contact hospital departments such as Medical Records, Utilization Review or external review organizations ... all necessary attachments required for billing (ie hard copy authorizations, medical records. 18-1. 50-1. etc.).Assures billing compliance standards are metCheck DDE… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print...over the nursing staff engaged in utilization review activities at Los Angeles General Medical ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,161.60 - $176,872.80 Annually… more