- Cambia Health Solutions, Inc (Portland, OR)
- Behavioral Health Utilization Management Clinician Work from home within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create ... provide utilization management (such as prospective concurrent and retrospective review ) to best meet the member's specific healthcare needs and to promote… more
- Staffing Now (Miami, FL)
- …remittance advice and check requestsPrepares Pharmacy billing for site nurses to review utilization and make necessary adjustments; Prepares and obtains ... to transmit batch claims to accounts payableCompletes all non-medical claims adjudication ( Home health services, ALF, nursing Home ) to include verifying claims… 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
- Veterans Affairs, Veterans Health Administration (San Francisco, CA)
- Summary The Patient Flow Utilization Management/ Utilization Review Consultant RN functions with advanced knowledge and skills to provide clinical ... with a collaborative, inter-disciplinary practice setting. Responsibilities The Patient Flow Utilization Management/ Utilization Review Consultant RN is… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …1. Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted ... for appropriate status determination. 2. Ensures compliance with principles of utilization review , hospital policies and external regulatory agencies, Peer… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …Duties: + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted ... for appropriate status determination. + Ensures compliance with principles of utilization review , hospital policies and external regulatory agencies, Peer… more
- Elevance Health (Columbus, OH)
- **Clinical Operations Associate Medical Director** **Carelon Health** **Genetics Testing Utilization Review ** **Location** : The ideal candidate will live within ... PulsePoint locations but will have options for work from home . **Schedule:** Monday - Friday, 9 AM-5:30 PM in...case reviews for their board certified specialty. + Makes physician to physician calls to gather medical… more
- The Cigna Group (Franklin, TN)
- The Chief Medical Officer (CMO) Utilization Management will develop and manage efforts to improve and maintain cost and utilization trends. Responsible for URAC, ... of insurance, and similar accreditors/regulators for the performance of all utilization management (UM) programs across the enterprise. The CMO is individually… more
- Point32Health (Canton, MA)
- …competence in directing operational compliance with CMS regulatory and NCQA, URAC ( Utilization Review Accreditation Commission) or DOI (Division of Insurance) ... the business processes and operations for all levels of utilization management review (ie, Precertification and Intake...plan medical staff and key provider - facility and physician or group - clinical leadership. The Director oversees… more
- HCA Healthcare (Campbell, CA)
- …to five years of experience in Managed Care, Provider Office, or Utilization Review organization required Physician Services Group ... provides satisfaction and personal growth, we encourage you to apply for our Utilization Management RN opening. We promptly review all applications. Highly… more
- Veterans Affairs, Veterans Health Administration (San Francisco, CA)
- …by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities **This is an OPEN CONTINUOUS ANNOUNCMENT ... become available.** VA offers a comprehensive total rewards package. VHA Physician Total Rewards. Education Debt Reduction Program (Student Loan Repayment): Learn… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …as we do to our patients. Our 20 hospitals, emergency and urgent care centers, home care and hospice, Flight for Life Colorado TM , telehealth and over 240 ... physician practices and clinics offer endless opportunities! Here, you...flourish and leaders who care about your success. The Utilization Management (UM) Director is responsible for the market(s)… more
- Kepro (CA)
- …a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team. Job Summary As a Utilization ... the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process. Adhering rigorously to standards set by NCQA,...Full-Time Clinical Reviewer Position is a Remote, work from home position based in the state of California. This… more
- Sanford Health (Fargo, ND)
- …secondary physician reviewers and appropriate referrals for secondary level review * Detailed reviewing of medical records to help improve patient care/outcomes ... continuum for assigned patient populations. This position primarily focuses on Utilization Management activities such as: * Evaluate medical necessity, efficiency… more
- Fallon Health (Worcester, MA)
- …monitor appropriate care and services in hospitals, skilled nursing facilities and home care settings to ensure quality, cost-effectiveness and continuity of care. ... to ensure the effectiveness of care management programs. Participates in physician reviewer and preauthorization meetings to coordinate and assure consistent… more
- WellSpan Health (York, PA)
- …PRN/Per Diem General Summary Provides direct supervision of case management and utilization review activities performed by the WellSpan Case Management staff. ... + Is a member of and attends the monthly Utilization Review committee, identifies cases for ...of care and verify need for peer to peer review -discuss with the CM nurse and/or attending physician… more
- The Mount Sinai Health System (New York, NY)
- …with their job descriptions and the VMG Compact + Participate in the annual physician performance review process in Oncology Services + **Engage in the ... co-Directors of Radiation Oncology; and the Lead APP for Oncology + Support physician within VMG Oncology Services in their clinical, education, and research roles +… more
- Sutter Health (San Francisco, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness ... health care services. The PA will develop expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical… more
- HCA Healthcare (Davie, FL)
- …flow, patient satisfaction, practice volume, billing and collections, service utilization , coding, physician and staff training. **Operational Effectiveness ... medical records, nursing, and ancillary services to ensure maximum utilization of resources and the efficient delivery of services...we encourage you to apply for our Director of Physician Services II opening. We promptly review … more
- Dartmouth Health (Lebanon, NH)
- …physician leadership experience are preferred. Dartmouth-Hitchcock Keene is seeking a Physician Advisor (PA) with expertise in Utilization Management, Care ... Overview Associate Medical Director - Cheshire Hospital Medicine Physician Advisor The Cheshire Medical Center’s Department of Hospital Medicine is a collaborative… more
