- Merck & Co. (North Wales, PA)
- …identified growth opportunities supported by vaccine launches and through increased utilization of our inline vaccines. The Contracting and Distribution Strategies ... access to our vaccines for our customers, including Wholesalers/Distributers, Physician Organization, Buying Groups, Health Systems, Medical Groups, Individual… more
- 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
- CaroMont Health (Gastonia, NC)
- …RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal ... practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case Management preferred. Minimum… more
- 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
- 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
- Cleveland Clinic (Vero Beach, FL)
- …or visit. Some of the responsibilities of a Utilization Management Specialist include medical record review , providing clinical information to payers, UM ... May design and initiate special projects as supervised by the Team Manager. Utilization Management Specialist Join our team at Cleveland Clinic Indian River… more
- Trinity Health (Pontiac, MI)
- …RN licensure within the State of Michigan. Certified Professional in Utilization Review /Management preferred. **C** **Special Skill / Aptitudes** Understanding ... care utilization management experience. Knowledge of regulations relative to utilization review . Knowledge of Federal, State and Local regulations sources.… more
- 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
- HCA Healthcare (Kansas City, MO)
- …access review audits.** **e) Tracks, monitors, and enhances provider utilization of HCA technologies, by offering at the elbow** **support and one-on-one ... compelling, we encourage you to apply for our Sr Provider Solutions Specialist opening. We promptly review all applications. Highly qualified candidates… more
- HCA Healthcare (San Antonio, TX)
- …opportunity compelling, we encourage you to apply for our Provider Solutions Specialist opening. We promptly review all applications. Highly qualified candidates ... where diversity and inclusion thrive? Submit your application for our Provider Solutions Specialist opening with ITG - San Antonio Division today and find out what… more
- 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
- WMCHealth (Valhalla, NY)
- …and coding principles and guidelines; good knowledge of healthcare delivery system, utilization review , case review and quality improvement practice ... Network CDI Physician Champion Company: NorthEast Provider Solutions Inc. City/State:...processes. The Physican Champion will provide clinically based concurrent review of patient medical records to ensure documentation accurately… more
- Sharp HealthCare (San Diego, CA)
- …be utilized for ongoing professional practice evaluation and re-credentialing.Collaborates with physician leadership to establish meaningful peer review criteria ... **What You Will Do** The purpose of the Sr. Performance Improvement Specialist is to improve clinical outcomes including responsibilities relating to leading teams… more
- Commonwealth Care Alliance (Farmington, MI)
- …works closely with participant providers within the organization's ACO and/or Physician 's Organization. The Provider Engagement Specialist will conduct reviews ... and define scope for on-site review and review period. + Work with physician 's office...Educate practices how PCMH capabilities lead to improved quality, utilization , and cost performance. + Other duties as assigned.… more
- Hackensack Meridian Health (Neptune, NJ)
- …inclusive of free text fields, to support the case management, utilization review process. + Retrieves information for the Physician Advisors as needed. + ... A day in the life of a **Care Coordination Specialist ** at **Hackensack Meridian** **_Health_** includes: ** Utilization ...+ Verifies admission and discharge date information. + Updates Utilization Review RN needed for payors. +… more
- HCA Healthcare (San Antonio, TX)
- …acute inpatient rehabilitation services prior to returning home. The Clinical Rehabilitation Specialist will review these patients daily until they have strong ... clinical evidence to request a physician order for a formal pre-admission assessment for acute...growth, we encourage you to apply for our Rehab Specialist opening. We promptly review all applications.… more
- Veterans Affairs, Veterans Health Administration (Spokane, WA)
- …of Geriatrics Rehabilitation Extended Care(GREC) Service, Mann Grandstaff VAMC. The CLC Staff Physician and Palliative Care Specialist will serve in three main ... Summary The Palliative Care Physician is assigned to the Community Living Center...the CLC for hospice/palliative care. Responsibilities This palliative care specialist will also contribute to and support the growth… more
- Novant Health (Winston Salem, NC)
- …BENEFITS SPECIALIST ** Novant Health is an integrated system of physician practices, hospitals, outpatient centers, and more - each element committed to ... the way on their journey to health and wellness. The Pharmacy Benefits Specialist at Novant Health works closely with the Pharmacy Benefits Manager (PBM), Benefits… more
- Carle (Urbana, IL)
- …on each applicable transfer, completes documentation per hospital guidelines.* Performs admission Utilization review on all direct admissions & transfers to ... RN- Clinical Admission Specialist + Department: Transfer Coordination - CMH +...EMTALA guidelines). Actively collaborates with providers, nursing, and case management/ utilization management to ensure appropriate patient placement for optimal… more
- Stanford Health Care (Palo Alto, CA)
- …one (1) year of experience as a licensed advanced practice provider: ( Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or Certified Registered ... Provides clinical direction and education, works closely with operational and physician leaders, and has oversight of hiring, termination, and professional growth… more
