- Elevance Health (Cerritos, CA)
- … Analyst I is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre service and post ... Title: Grievance/ Appeals Analyst I Virtual: This role enables associates...and requirements. As such, the analyst will strictly follow department guidelines and tools to conduct their reviews. The… more
- Community Health Systems (Franklin, TN)
- …regarding utilization review concerns. Supports training initiatives within the department and escalates complex issues to management as needed. Performs other ... Job Summary The Clinical Utilization Review Specialist is responsible for evaluating the...conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
- Community Health Systems (Franklin, TN)
- … Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals activities. This ... timely authorizations for hospital admissions and extended stays. The Utilization Review Coordinator monitors and documents all authorization activities, assists… more
- Mount Sinai Health System (New York, NY)
- …Experience Requirements Previous experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. ... Job Description RN/Case Manager MSH Case Management FT Days The Case...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- Houston Methodist (Katy, TX)
- At Houston Methodist, the Manager Revenue Cycle position is responsible for the daily management of the staff and operations for one or more of the following areas ... to: medical coding, insurance billing, collections, patient account resolution, appeals /denials, customer service, cash applications, revenue integrity, etc. This… more
- Rush University Medical Center (Chicago, IL)
- …Illinois Business Unit: Rush Medical Center Hospital: Rush University Medical Center Department : Ambulatory Care Management Work Type: Full Time (Total FTE between ... a care management team that is responsible for promoting effective resource utilization to achieve an optimal clinical outcome. The Care Management Navigator applies… more
- University of Colorado (Colorado Springs, CO)
- …of Operations. The position also maintains a dotted-line relationship with the Business Manager for Division Finances and HR and the Director of Auxiliary Finance. ... Operations. Ensure alignment of business operations, auxiliary facilities space utilization , auxiliary growth opportunities, and student-focused service delivery. (20%)… more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and ... to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials… more
- Huron Consulting Group (Chicago, IL)
- …our team as the expert you are now and create your future. The Manager of Utilization Management is responsible for planning, organizing, developing, and ... Review Plan and the overall operation of the Utilization Management Department in accordance with federal,...Performance Tracking and Improvement: Provides analysis and reports of utilization , denials, and appeals KPIs, trends, patterns,… more
- Children's Mercy Kansas City (Kansas City, MO)
- …review functions utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and hospital performance ... to integrated inpatient teams; assists Director in the management of department ; including personnel and fiscal management and development of, and training… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... concurrent and extended stay reviews. + Prepares and submits appeals to third party payors. + Maintains appropriate records...third party payors. + Maintains appropriate records of the Utilization Review Department . + Performs related duties,… more
- Corewell Health (Grand Rapids, MI)
- …all components of insurance prior authorizations, initial reviews, continuous stay reviews and appeals . Nurse Care Manager - Plans and prioritizes care for ... Wednesday, Thursday, Friday (4 hours), mostly remote, occasional on-site About the Department : RN UM - Supporting the insurance coordination functions for the Helen… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... ensure compliance with utilization management policies. This role conducts admission and continued...conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
- University of Utah Health (Salt Lake City, UT)
- …advancement, and overall patient outcomes. **Responsibilities** + Applies approved utilization criteria to monitor appropriateness of admissions with associated ... or third-party payer. + Alerts and discusses with physician/provider and case manager /discharge planner when patient no longer meets medical necessity criteria for… more
- Community Health Systems (Franklin, TN)
- … Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals activities. This ... timely authorizations for hospital admissions and extended stays. The Utilization Review Coordinator monitors and documents all authorization activities, assists… more
- Saint Francis Health System (Tulsa, OK)
- …requires a minimum number of worked hours per month as needed by the department ; limited benefit offerings. Variable **This position is classified as ECB and will be ... in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal… more
- Healthfirst (NY)
- …and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** + **Lead ... but not limited to Care Management, Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions** + **Partner… more
- Calvary Hospital (Bronx, NY)
- …reimbursement and quality issues. 16. Communicates identified issues relating to quality, utilization , risk and discharge planning to the Department Director. ... The RN Case Manager (RNCM) will be responsible for all aspects...length of stay (ELOS). The RNCM participates in the Utilization Review, Discharge Planning, Risk Management, and Quality Assessment… more
- Sharp HealthCare (San Diego, CA)
- …documents as appropriate in the electronic medical record and provides information to the department head as indicated. + Utilization review and utilization ... **Facility:** Sharp Memorial Hospital **City** San Diego ** Department ** **Job Status** Regular **Shift** Day **FTE** 1...1 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager … more
- Trinity Health (Philadelphia, PA)
- …experienced RN Care Manager to join our team in the Emergency Department ! **Schedule:** Full-time - Day Shift, 10-hour shifts **:** Under the general supervision ... of the Director of Care Coordination, the Emergency Department Care Manager assists physicians and the interdisciplinary team in facilitating the entry of… more
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