- Northeast Georgia Health System, Inc (Braselton, GA)
- …in order for completion of the pre-certification process.Works in conjunction with Physician offices, Case Management, Utilization Review , and patients ... health of our communities. About the Role:Job SummaryUnder the supervision of the Utilization Review Manager, this position is responsible for ensuring the… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** The Senior Utilization Review Physician Specialist collaborates with the healthcare team in the management and resolution of activities that ... 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)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Denials Specialist - Utilization Review responsibilities include:** + Timely reviews ... year Medicaid/Medicare experience. Equal Opportunity Employer Veterans/Disabled **Position** Denials Specialist - Utilization Review **Location**… 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 ... Bi-Weekly Hours: 80** **_Position Summary_** **:** In conjunction with the admitting/attending physician , the UR Specialist RN assists in determining the… more
- Bakersfield Behavioral Healthcare Hospital (Bakersfield, CA)
- …leadership, teamwork, and communication skills. ESSENTIAL DUTIES The primary responsibility of the Utilization Review Specialist is to review medical ... of candidates. Education Associates Degree preferred Minimum Work Experience Utilization Review experience preferably in a behavioral/psychiatric healthcare… 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
- 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
- Corewell Health (Caledonia, MI)
- …continued stay. Educates medical staff/other health care professionals regarding utilization management and quality requirements. Makes recommendations and provides ... financial and utilization management (UM) information to other members of the...+ Identifies quality indicators to facilitate process improvement and physician education. How we will care for you, while… 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 will facilitate, coordinate, and approve… more
- Cleveland Clinic (Weston, FL)
- …Miami-Fort Lauderdale metro area and remains a top hospital in Florida. As a Utilization Management (UM) Specialist , you will work under the general supervision ... of the UM Team Manager to perform UM activities which include admission review , concurrent review , retrospective chart review and clinical systems review … more
- Providence (Santa Rosa, CA)
- … performance/behavioral deficiencies as requested0 + Assists in formal Peer Review activities. + Prepares physician employment agreements for physicians ... for Health System and clinics. + Effectively obtains, interprets, and analysis physician information and utilization data. + Communicate regularly with referring… 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
- UC Health (Cincinnati, OH)
- …Cincinnati. UC Medical Center is also home to medical breakthroughs- our physician experts conduct basic, translational and clinical research, leading to new ... Cincinnati's only Level I adult trauma center, which includes the right mix of specialist and medical resources available at a moment's notice for a wide variety of… more
- St. Luke's University Health Network (Allentown, PA)
- …registrations and/or physician queries + Serves as liaison between Physician Advisor/Medical Director, Finance, Utilization Review Department and ... patient's ability to pay for health care. The Surgical Review Specialist prospectively reviews, validates, and audits...lost with feedback to respective departments + Conduct concurrent review with utilization review department… more
- Tufts Medicine (Burlington, MA)
- …as a physician advisor **Preferred Qualifications:** 1.Prior experience in utilization review /secondary review desired **Duties and Responsibilities:** ... , case management, and revenue cycle functions. 7.Provides clinical support to the utilization review and clinical documentation specialist for resolution of… more
- HCA Healthcare (Overland Park, KS)
- …facilitates access review audits. e) Tracks, monitors, and enhances provider utilization of HCA technologies, by offering at the elbow support and one-on-one ... personal growth, we encourage you to apply for our Sr Provider Solutions Specialist opening. We promptly review all applications. Highly qualified candidates… more
- HCA Healthcare (Chattanooga, TN)
- …this opportunity compelling, we encourage you to apply for our Provider Solutions Specialist PRN -Parkridge opening. We promptly review all applications. Highly ... where diversity and inclusion thrive? Submit your application for our Provider Solutions Specialist PRN opening with Parkridge Medical Center today and find out what… more
- AdventHealth (New Smyrna Beach, FL)
- … physician identification and scheduling of follow-up PCP and specialist appointments for post-hospital follow up care. Ensures discharge disposition accuracy ... New Smyrna Beach **The role you'll contribute:** _The_ _Social Work Specialist intervenes with patients who have complex psychosocial needs, require assistance… more
- Mohawk Valley Health System (Utica, NY)
- … regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of...and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides… more
- Ventura County (Ventura, CA)
- HS Client Benefit Specialist Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4440930) Apply HS Client Benefit Specialist Salary $44,512.49 ... of strengthening partnerships and join Ventura County as a HS Client Benefit Specialist ! WHAT WE OFFER The County of Ventura offers an attractive compensation and… more