- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** **The Utilization Review Physician 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
- Henry Ford Health System (Detroit, MI)
- …practicing as a physician . + Previous experience as Director of Utilization Review or Physician Advisor preferred. CERTIFICATIONS/LICENSURES REQUIRED: + ... The Medical Director of Utilization Review is responsible for the...a timely manner 9. Code 44s - UM committee physician concurrent statement. CMS Conditions of Participation 10. Lead… 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
- Munson Healthcare (Traverse City, MI)
- … Advisors ( ACPA), American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP), or American Physician Leaders in Case Management ( ... Sub-Specialty Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. ORGANIZATION EXPECTATIONS +… more
- Catholic Health Initiatives (Chattanooga, TN)
- …by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. + Physician Advisor Sub-specialty Certification ... the hospital through teaching, consulting, and advising the care management and utilization review departments, medical staff members, and the hospital… more
- Billings Clinic (Billings, MT)
- …starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings Clinic ... - 44.18 Under the direction of department leadership, the Utilization Review / Management RN. This position is...information supporting status or LOC, escalate case to the physician advisor for second level review as… more
- The County of Los Angeles (Los Angeles, CA)
- …Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician member of the ... UTILIZATION REVIEW NURSE SUPERVISOR II Print...by subordinate supervisors on number and status of reviews, physician advisor referrals, and type of physician … more
- Munson Healthcare (Traverse City, MI)
- …interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic work ... State of Michigan. + Minimum of three years clinical experience required. Previous utilization review and/or case management in a hospital or insurance industry… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 241106-5613FP-001 Location East Hartford, CT Date Opened 11/7/2024 12:00:00 AM Salary ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=)… 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
- Actalent (San Bernardino, CA)
- Description: As a part of the Utilization Management team the Utilization Review RN is a member of the Care Coordination team. The goal of care coordination ... as it relates to acute inpatient stay and post-acute facility stay. The Utilization Review RN Coordinates continuing care/outside services for value based risk… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of care and promoting ... planners regarding transition to alternative levels of care. + Perform concurrent utilization review applying identified criteria at prescribed review … 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
- 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
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review , under the supervision and in collaboration with the ... Manages the activities of hospital staff in inpatient care coordination and utilization review . Oversees interactions of staff with outside activities and… more
- Covenant Health (Nashua, NH)
- …health care team. + Annual goals are achieved. + Attends pertinent case management/ utilization review programs to maintain current knowledge of UR practices. + ... for patients not meeting criteria by utilizing second level review / Physician Advisor services. + Identifies...+ Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all… 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...will help our hospital clients by working alongside our Physician Advisory team to provide first-level initial admission and… more
- Baptist Memorial (Jackson, MS)
- Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and appropriateness of healthcare services and treatment as prescribed ... by utilization review standards. The UR Nurse works...necessity or other areas when indicated + Communicates with physician advisors related to status concerns or denials +… more
- Tufts Medicine (Tyngsboro, MA)
- …to resolve accounts, including Patient Access, Revenue Integrity, Coding, Medical Records, Utilization Review , Hospital Departments, Physician 's Offices, and ... eligibility verification, billing edits, claim edits, payer follow-up, correspondence review , corrected claims, appeals, reimbursement verification, and remittance for… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: This Utilization Review Denials Review Unit (DRU) 3 Team Lead will assist the Director of Utilization Review and the Associate Director ... of Utilization Review with daily staff mentoring, leadership and resource provision....required for interface and collaboration with leadership, colleagues, providers, Physician Advisors, regulatory agencies, and other health care related… more