- HonorHealth (Scottsdale, AZ)
- …across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary Reviews and monitors utilization of health care services with the goal of maintaining ... high quality cost-effective care . Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient… more
- Covenant Health (Nashua, NH)
- … care team. + Annual goals are achieved. + Attends pertinent case management/ utilization review programs to maintain current knowledge of UR practices. + Acts ... services and Outpatients in a Bed. Identifies delays in care . Documents and communicates findings with the care...+ Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all… more
- Actalent (Omaha, NE)
- …in medical review or utilization management. + Knowledge of utilization review , Medicare, utilization management, and EMR systems. Additional Skills ... Job Title: Utilization Management NurseJob Description We are seeking a...preauthorization processing. This role involves accurate and timely medical review of claims, preauthorizations, and customer service inquiries. You… more
- Stanford Health Care (Palo Alto, CA)
- …: Examine patient medical records to ensure the necessity and appropriateness of care provided. 3. Utilization Review : Conduct thorough utilization ... for this role. **This is a hybrid Stanford Health Care job.** **A Brief Overview** The Utilization ...utilization management principles. + Experience in case management, utilization review , or related healthcare roles. +… more
- Travelers Insurance Company (Buffalo, NY)
- …**What Is the Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for ... **Who Are We?** Taking care of our customers, our communities and each...to the compensable injury and for adhering to multi-jurisdictional Utilization Review criteria. **What Will You Do?**… more
- WellSpan Health (York, PA)
- …in payor denials and appeals. + Serves as point of contact for System acute care utilization review issues and resolutions with payers. Collaborates with ... + Oversees the utilization management process for preauthorization, concurrent review , denials and appeals for System acute care facilities. +… more
- Actalent (Doral, FL)
- … + Utilization management + Concurrent review + Utilization review + Prior authorization + Health care + Medicaid + Medicare + Milliman commercial ... Utilization Management Nurse Job Description The role of...and coordination across settings, identifying member needs, planning for care , monitoring the efficacy of interventions, and advocating to… more
- Geisinger (Danville, PA)
- …key role in ensuring information is released to payers and physician level review . Frequently works with highly sensitive and confidential information. Job Duties + ... a resource to departmental staff regarding insurance contacts. + Maintains Utilization management SharePoint site to reflect updated payor information. +… more
- Actalent (Orlando, FL)
- …claims and preauthorization processing - Responsible for accurate and timely medical review of claims and preauthorization's - Responsible for accurate and timely ... medical review of customer service inquirers about claims and preauthorization's...directors and pharmacists to ensure medically appropriate, high-quality, cost-effective care , promote positive member outcomes, effective use or resources,… more
- HonorHealth (Scottsdale, AZ)
- …Required Experience 5 years in healthcare with experience in pre-certification Required 3 years experience in utilization review , medical management Required ... meaningful? At HonorHealth, you'll be part of a team, creating a multi-dimensional care experience for our patients. You'll have opportunities to make a difference.… more
- Stanford Health Care (Palo Alto, CA)
- … Management: Avoidable Delay Identification, Intervention & Tracking, Utilization Review , Medical Necessity Review , Care Plan Progression, Pre-Admission ... to be part of our legacy of hope and innovation , we encourage you to take the first step...facets of a patient's admission/discharge or outpatient visit/follow-up; performing utilization review activities, including review … more
- Nuvance Health (Danbury, CT)
- …Develop and implement a comprehensive, patient-centric vision and strategy for system-wide care coordination, encompassing utilization review (UR), denials ... for providing strategic leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff… more
- UNC Health Care (Rocky Mount, NC)
- …cost-efficient care of patients through such case management functions as utilization review and discharge planning. May facilitate the execution of existing ... reviews for private insurance companies, Medicare and Medicaid, in accordance with utilization review guidelines. Tactfully and effectively informs Manager of… more
- Stanford Health Care (Palo Alto, CA)
- …and Abilities** + Knowledge of principles and best practices of case management, utilization review , social work, care coordination and discharge planning. ... + Ability to drive a culture of proactive, integrated, high quality patient care , innovation , transformation, and change within the department. + Ability to… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... to be part of our legacy of hope and innovation , we encourage you to take the first step...requested clinical and psychosocial information to assure reimbursement. + Utilization Review -- Reviews prospectively, concurrently and… more
- Actalent (Dallas, TX)
- …to determine the medical necessity of services and appropriate levels of care in accordance with national standards, contractual requirements, and member benefit ... appropriate medical team to promote quality and cost-effectiveness of medical care . Responsibilities + Analyze prior authorization requests to determine medical… more
- Spira Care, LLC (Olathe, KS)
- …at least three years of Care /Case/Disease Management, Health Plan, or Utilization Review experience + Thorough understanding of advanced primary care ... other Care Centers to share best practices and foster innovation . + Acts as a critical " Care Team" member and works closely with the providers and staff to… more
- Houston Methodist (Houston, TX)
- …resources. The Physician is a key member and leader of the hospital's utilization review /management committee, which is charged with regulatory goals of ensuring ... care , length of stay, and quality issues. + Chair the utilization review /management committee, actively participates in defining operational strategic… more
- Swedish Health Services (Seattle, WA)
- …teams, both internal and external to the organization, to improve patient care through effective utilization and monitoring of healthcare resources and ... and uses creative problem solving for complex discharge planning, quality of care , and utilization issues. Explores new resources when the opportunities… more
- Swedish Health Services (Seattle, WA)
- …teams, both internal and external to the organization, to improve patient care through effective utilization and monitoring of healthcare resources and ... and uses creative problem solving for complex discharge planning, quality of care , and utilization issues. Explores new resources when the opportunities… more