- Kelsey-Seybold Clinic (Houston, 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 ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Lawrence General Hospital (Lawrence, MA)
- The Utilization Review Specialist , under supervision and in collaboration with the Utilization Review Coordinator, Utilization Review Nurses, ... well as the integrated care team and supports the case management/ utilization review team on system-wide quality improvement/performance improvement initiatives.… more
- Munson Healthcare (Traverse City, MI)
- …families, interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic ... Michigan. + Minimum of three years clinical experience required. Previous utilization review and/or case management in a hospital or insurance industry preferred… more
- Westborough Behavioral Healthcare Hospital (Westborough, MA)
- …Time + Employee Discount Program + Employee Assistance Program Job Description: The Utilization Review Specialist is responsible for monitoring adherence to ... Westborough Behavioral Healthcare Hospital is looking for a UR Specialist to provide Per Diem coverage. Benefits Include +...the hospital's utilization review plan to ensure the effective… more
- Medical Center Hospital (Odessa, TX)
- Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician Advisors. Education: Holds a current Texas license as a Registered… more
- Community Health and Counseling Services (Bangor, ME)
- Insurance Verification and Utilization Review Specialist - Health Services Job Type(s):Full-Time Location(s):Bangor, Maine Education:Associates Degree - ... staff, patients, family members, facilities and physician. Responsible for utilization management of services, verifying authorization of services throughout… 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
- 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
- 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
- MetroHealth (Cleveland, OH)
- …**Responsible for communicating information to internal and external customers of the Utilization Review and Care Management Department. Follows up on inquiries ... from payors and provides the appropriate information to Utilization Review , providers, payors, and admitting. Upholds the mission, vision, values, and customer… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for ... documentation from the physician(s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if...documented in the case management system by the UR Review Specialist . + In the event a… more
- BayCare Health System (Clearwater, FL)
- …a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + ... + Preferred Masters in Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years in Case Management or + Required 3… more
- Community Health Systems (Franklin, TN)
- …necessity, both for admission to the hospital as well as continued stay. The Utilization Review Clinical Specialist supports and coordinates the various ... and extended hospital stays with portals, faxes and phone calls. The Utilization Review Clinical Specialist will monitor adherence to the hospital's … more
- Cleveland Clinic (Weston, FL)
- …or visit. Some of the responsibilities of a Utilization Management Specialist include medical record review , providing clinical information to payers, UM ... Utilization Management Specialist Join Cleveland Clinic...Management (UM) Specialists perform UM activities, such as admission review , concurrent review , retrospective chart review… more
- Alameda Health System (Oakland, CA)
- …specific clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post ... System Utilization Management Specialist + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Care Management + Req… 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
- Penn State Health (Hershey, PA)
- …and family medical or genetic information._ **Union:** SEIU Healthcare Pennsylvania **Position** Utilization Management Specialist - DAY SHIFT - Utilization ... at ###@pennstatehealth.psu.edu (MAILTO://###@pennstatehealth.psu.edu) **SUMMARY OF POSITION:** Responsible for the review of clinical documentation in the Electronic Medical Record… more