• Novo Nordisk Inc. (Milwaukee, WI)
    …and unique insights Leverages superior understanding of complexities within the targeted physician customer base in order to maximize performance Applies high level ... appropriate patients that would benefit in order to ensure early trial and utilization Generates advocacy for Novo Nordisk products and services by sharing approved… more
    HireLifeScience (01/23/25)
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  • Physician Utilization Review

    Hackensack Meridian Health (Hackensack, NJ)
    **Overview** The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
    Hackensack Meridian Health (11/18/24)
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  • Utilization Review Specialist

    Munson Healthcare (Traverse City, MI)
    …families, interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic ... State of Michigan. + Minimum of three years clinical experience required. Previous utilization review and/or case management in a hospital or insurance industry… more
    Munson Healthcare (11/09/24)
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  • PRN Utilization Review Clinical…

    Community Health Systems (Franklin, TN)
    …additional documentation from the physician (s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if physicians are ... of medical services and procedures in the hospital setting. Utilization review is the assessment for medical...have an ED Case Manager present, the UR Clinical Specialist will collaborate with Emergency Room Physician /staff… more
    Community Health Systems (01/19/25)
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  • Utilization Review Specialist

    Lawrence General Hospital (Lawrence, MA)
    The Utilization Review Specialist , under...with the Utilization Review Coordinator, Utilization Review Nurses, Physician advisor ... well as the integrated care team and supports the case management/ utilization review team on system-wide quality improvement/performance improvement initiatives.… more
    Lawrence General Hospital (12/21/24)
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  • Utilization Review Specialist

    Sutter Health (Berkeley, CA)
    …and others to ensure appropriate utilization and quality care through utilization review , tracking and evaluation and objectively compare criteria with ... clinical nursing staff and other departments regarding documentation required for utilization review activities and processes. Collaborate with medical, nursing… more
    Sutter Health (01/22/25)
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  • RN Utilization Review

    HonorHealth (Scottsdale, AZ)
    …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
    HonorHealth (12/03/24)
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  • Utilization Review Admission…

    Mount Sinai Health System (New York, NY)
    …Operating Room Surgical Scheduling, Mount Sinai West - Full Time, Days** The Utilization Review Specialist coordinates scheduling of all surgical/endoscopic ... **Job Description** ** Utilization Review Admission Specialist ...and operating roaom time. 7. Checks credentials system for physician 's delineation of privileges for equipment and/or procedures according… more
    Mount Sinai Health System (12/04/24)
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  • Utilization Review Specialist

    Medical Center Hospital (Odessa, TX)
    Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician Advisors. Education: Holds a current Texas license as a… more
    Medical Center Hospital (12/21/24)
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  • Insurance Verification and Utilization

    Community Health and Counseling Services (Bangor, ME)
    Insurance Verification and Utilization Review Specialist - Health Services Job Type(s):Full-Time Location(s):Bangor, Maine Education:Associates Degree - ... collaborating with Agency staff, patients, family members, facilities and physician . Responsible for utilization management of services, verifying… more
    Community Health and Counseling Services (01/08/25)
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  • RN Utilization Review

    Corewell Health (Grand Rapids, MI)
    …continued stay. Educates medical staff/other health care professionals regarding utilization management and quality requirements. Makes recommendations and provides ... financial and utilization management (UM) information to other members of the...+ Identifies quality indicators to facilitate process improvement and physician education. + Ensure members are authorized for the… more
    Corewell Health (01/24/25)
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  • Utilization Management Nurse…

    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
    LA Care Health Plan (01/24/25)
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  • Utilization Management Specialist

    Cleveland Clinic (Weston, FL)
    …or visit. Some of the responsibilities of a Utilization Management Specialist include medical record review , providing clinical information to payers, UM ... Utilization Management Specialist Join Cleveland Clinic...Management (UM) Specialists perform UM activities, such as admission review , concurrent review , retrospective chart review more
    Cleveland Clinic (01/23/25)
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  • Utilization Rev Appeals Spec

    University of Michigan (Ann Arbor, MI)
    Utilization Rev Appeals Spec Apply Now **Job Summary** **Why Join Michigan Medicine's Hospital Billing Audits & Appeals (HBAA) Department?** The Audit and Appeals ... Specialist has a strong knowledge of medical appeal and...Registration, MiVisit Business services, clinics and ancillary departments. + Review patient medical records and utilize clinical and regulatory… more
    University of Michigan (01/17/25)
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  • Surgical Review Specialist

    St. Luke's University Health Network (Allentown, PA)
    …registrations and/or physician queries + Serves as liaison between Physician Advisor/Medical Director, Finance, Utilization Review Department and ... patient's ability to pay for health care. The Surgical Review Specialist prospectively reviews, validates, and audits...lost with feedback to respective departments + Conduct concurrent review with utilization review department… more
    St. Luke's University Health Network (10/31/24)
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  • Utilization Management Coordinator…

    Sanford Health (SD)
    …also acceptable, ie Certified Coding Specialist (CCS), Certified Coding Specialist - Physician based (CCS-P), Certified Professional Coder (CPC), Certified ... Details** opportunity to work remote **Job Summary** Monitors the utilization of resources, risk management and quality of care...is not exceeded without due notice to the attending physician . May also need to notify physician more
    Sanford Health (12/17/24)
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  • PRN UR Clinical Specialist (Remote)

    Community Health Systems (Franklin, TN)
    …necessity, both for admission to the hospital as well as continued stay. The Utilization Review Clinical Specialist supports and coordinates the various ... hospital stays with portals, faxes and phone calls. The Utilization Review Clinical Specialist will...for admission and request appropriate additional documentation from the physician (s). + Documents all actions and activities related to… more
    Community Health Systems (01/16/25)
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  • Consulting Provider Solutions Specialist

    HCA Healthcare (Kansas City, MO)
    …goals. Unlock your potential! **JOB SUMMARY:** The Consulting Provider Solutions Specialist serves as a subject-matter expert for physician -facing technologies. ... growth, we encourage you to apply for our Consulting Provider Solutions Specialist opening. We promptly review all applications. Highly qualified candidates… more
    HCA Healthcare (12/24/24)
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  • Physician Advisor

    Mohawk Valley Health System (Utica, NY)
    … regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of...and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides… more
    Mohawk Valley Health System (12/18/24)
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  • Care Management Clinical Appeals Specialist

    Alameda Health System (San Leandro, CA)
    utilization and an appropriate level of care. 5. Coordinates all utilization review functions, including response to payor requests for concurrent and ... Care Management Clinical Appeals Specialist + San Leandro, CA + Finance +...of Case Management experience in an acute setting or utilization review at a medical group or… more
    Alameda Health System (01/23/25)
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