- Altru Health (East Grand Forks, MN)
- …initiating and participating in restructuring of current and new programs. Performs utilization review when required. Collaborates with Primary Care Provider ... Collaborates with community resources to deliver services that promote quality outcomes and continuity of care. Monitors program effectiveness...| Within 90 Days of Start Date | Learning Management System Notes: Can by licensed as LCSW or… more
- CaroMont Health (Gastonia, NC)
- …in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management , Quality and/or Case Management preferred. ... to MCO via fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments,… more
- Kepro (AR)
- … of clinical records. Preferred Qualifications/Experience: + Utilization Review / Utilization Management experience. + Clinical quality review ... + 2+ years of experience in a behavioral health setting, conducting behavioral health utilization reviews or behavioral health case management . + Ability to work… 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 ... advisor and external review organizations to ensure quality outcomes, patient throughput, and appropriate resource utilization...in an acute healthcare setting required, preferably with case management , utilization review or closely… more
- Prime Healthcare (Ontario, CA)
- …is actively seeking new members to join our corporate team! Responsibilities VP Utilization Review and Clinical Denials Management will provide strategic ... leadership, direction and operational management for the Utilization Review and Clinical Denial Management teams. This position encompasses process… more
- Beth Israel Lahey Health (Burlington, MA)
- …Case Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality assurance for Lahey Clinic ... to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management ...needed. 10) Supports all service line activities related to utilization and quality management . 11)… more
- Sutter Health (Berkeley, CA)
- …managers, clinical nursing staff and others to ensure appropriate utilization and quality care through utilization review , tracking and evaluation and ... systems for the appeal/denial process, tracks and trends data, and coordinates utilization management activities for the assigned area. Collaborates with… 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
- 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
- Stanford Health Care (Palo Alto, CA)
- …Skills and Abilities** + Knowledge of principles and best practices of case management , utilization review , social work, care coordination and discharge ... practice. Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation,… more
- Munson Healthcare (Traverse City, MI)
- …the State of Michigan. + Minimum of three years clinical experience required. Previous utilization review and/or case management in a hospital or insurance ... assessment and critical thinking skills necessary to provide utilization review responsibilities. Superior organization and time management skills required;… more
- Great River Health (West Burlington, IA)
- …anticipate executive needs, and take initiative in managing tasks. Qualifications: Quality Department Administrative AssistantAssists Utilization Review by ... in medical charts per defined policy and procedures.Administer required Medicare forms per Utilization Review direction. Benefits: We are excited to offer an… more
- CenterLight Health System (NY)
- …of experience in care/case management , disease management , population health management , utilization review , quality assurance, or discharge ... escalate issues of changes to ensure proper care and management of cases are followed. + Promotes and educates...Escalates questions or concerns during the assessment to the quality review team to ensure appropriate completion… more
- Providence (Mission Hills, CA)
- **Description** Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost ... License upon hire + 3 years of experience in utilization management and/or case management ....line within Providence serving patients across seven states with quality , compassionate, coordinated care. Collectively, our medical groups and… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, ... more at UCLA Health. You will play a key part in promoting high- quality , cost-effective medical care by applying clinical acumen and applicable policies and… more
- R1 RCM (Pittsburgh, PA)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. **Title: Utilization Review Author** **Location: Hospital Client located in ... vary and some flexibility may be offered** As our ** Utilization Review Author** , you will help...have experience in a clinical inpatient environment and hospital-based utilization or case management experience. Proficiency in… more
- LifePoint Health (Hancock, MI)
- …Our Utilization Review RN will be part of an excellent team of Case Management RN's. As a Utilization Review RN you will work in multiple electronic ... our employees both professionally and personally. We are seeking a detail-oriented Utilization Review Registered Nurse to be responsible for prior authorizations… more
- Trinity Health (Springfield, MA)
- …**Shift:** Rotating Shift **Description:** Requires BSN At **Mercy Medical Center** the ** Utilization Review /Appeals & Denials** **RN** performs utilization ... physician, bedside Registered Nurse, ICC and Social Worker with utilization management and clinical coordination of the...and their families. **What you will do** + Perform utilization review and payer notification + Establish… more
- US Tech Solutions (Chicago, IL)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE...with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an… more
- ERP International (Nellis AFB, NV)
- … Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); Comprehensive Accreditation ... Utilization Management activities and functions by using MTF specific Quality Improvement processes to identify areas for review from data, suspected… more
