- Kelsey-Seybold Clinic (Pearland, TX)
- **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to ... services requiring authorization prior to services being rendered for members. The Utilization Review Specialist (LVN) serves as a liaison in reviewing… 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 ... patient population and HackensackUMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- BayCare Health System (Cotton Plant, AR)
- …responsibility and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding ... and compassionate team. **The Utilization Review Specialist Senior responsibilities include:** + Functions as the primary liaison between the funding agents… more
- Sanford Health (Thief River Falls, MN)
- …$26.00 - $41.50 **Department Details** Come join our Behavioral Health team as a Utilization Review Specialist utilizing a team-based approach to patient ... clinical setting required. Preference given to individuals with experience in utilization or with CPT/ICD knowledge. Currently holds an unencumbered Licensed… more
- Spectrum Billing Solutions (Skokie, IL)
- …Excel, billing software). + Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management ... Specialist | Insurance Specialist | UR Specialist | Revenue Cycle Utilization Review Specialist | ABA Utilization Review Specialist |… more
- HonorHealth (Scottsdale, AZ)
- …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… 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 (OR Scheduler),… more
- McLaren Health Care (Bay City, MI)
- …management to expedite patient discharge. 4. Maintains current knowledge of hospital utilization review processes and participates in the resolution of ... 0 **Position Summary:** In conjunction with the admitting/attending physician, the UR Specialist RN assists in determining the appropriate admission status based on… more
- Reno Behavioral Healthcare Hospital (Reno, NV)
- The UR Specialist reviews and monitors patients' utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties ... include providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency...of care that may be covered. + Monitors all utilization reports to assure compliance with reporting and turnaround… more
- Henry Ford Health System (Wyandotte, MI)
- …The support specialist is a support role crucial to the centralized Utilization Review team for time sensitive authorization tracking and resolution process. ... Responsible for obtaining and tracking approvals, denials, and additional information requests received from third party payers within the EMR. EDUCATION AND EXPERIENCE: High School Diploma/GED Working knowledge of computers and software systems Communication… more
- ProMedica Health System (Toledo, OH)
- The Payor Specialist is responsible for payor notification, and securing authorizations for all admissions systemwide. They receive and answer voicemail and process ... faxes sent by the payers which includes authorizations, denials and requests for more information. They also act as the resource for the department for all payer information. ACCOUNTABILITIES *All duties listed below are essential unless noted otherwise*… more
- Amity Foundation (Tucson, AZ)
- …is an entry-level position and assists the Clinical Advisor, Campus Demonstrators and the Utilization Review Specialist with the collection and writing of ... a desire to teach, learn and join our community as The Clinical Documentation Specialist , this groundbreaking opportunity will allow you to work with our prison and… more
- Fairview Health Services (St. Paul, MN)
- …meets regulatory requirements. Participates in interdisciplinary communication related to utilization review issues. Educates on status. Provides all ... M Health Fairview has an immediate opening for a Utilization Management Specialist RN. This position provides...+ Current RN licensure in MN + 3-5 years utilization review or case management experience in… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and approve… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- LifePoint Health (Athens, TN)
- …seeking talent to fill the position of Intake Nurse and Utilization Specialist for ourGeroPsychDepartment.This job is permanent,full-time. Core competencies ... **Starr Regional Medical Center* **Title:** * Intake Nurse and Utilization Specialist * **Location:** *Tennessee-Athens* **Requisition ID:** *7412-6736* more
- Mount Sinai Health System (New York, NY)
- …Beth Israel **Responsibilities** Responsible for all aspects of the concurrent review program, insurance certification, and authorization process for all Psychiatric ... by management) and for all aspects of the initial review on an as needed basis Develops rapport with...providers as well as regulatory agencies, as needed for Utilization Management activities Demonstrates the knowledge and skills necessary… more
- AdventHealth (Altamonte Springs, FL)
- …The Senior Manager of Utilization will oversee ED, Inpatient, and Specialist utilization , and manage care management outcomes. The Senior Manager of ... . Develops and implements case management programs and education, including utilization review , transitions of care, disease management, population health… more
- Huron Consulting Group (Chicago, IL)
- …as the expert you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring the appropriate ... to facilitate optimal patient outcomes while managing healthcare costs. The Utilization Management Specialist ensures compliance with regulatory requirements and… 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