- Cleveland Clinic (Vero Beach, FL)
- …visit. Some of the responsibilities of a Utilization Management Specialist include medical record review, providing clinical information to payers, UM ... Manager. May design and initiate special projects as supervised by the Team Manager. Utilization Management Specialist Join our team at Cleveland Clinic… more
- Spectrum Billing Solutions (Skokie, IL)
- …mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist | UR Specialist | Revenue ... utilize his or her knowledge and skills to review clinical information and obtain initial and continuing authorizations for... Utilization Review Specialist | ABA Utilization Management Specialist | ABA… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... clinical expertise and critical thinking skills, the Utilization Review Specialist , will analyze clinical... Nurse Specialist Preferred **Experience:** 5 years Clinical nursing experience. 2 years Care Management .… more
- Hackensack Meridian Health (Hackensack, NJ)
- …compliance a. Provides direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight for ... **Overview** The Senior Utilization Review Specialist collaborates with the...Interfaces with Clinical Team in regards to Utilization Management and evidence based medicine e.… 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 ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...Nursing Experience Required: At least 5 years of varied clinical experience in an acute hospital setting. At least… more
- ManpowerGroup (Durham, NC)
- Our client, the largest health care industry, is seeking a utilization management specialist to join their team. If you are detail-oriented, experienced in ... background, we encourage you to apply for this remote opportunity. **Job Title:** Utilization Management Specialist **Location: REMOTE** **Pay Range: $24/hr… more
- CaroMont Health (Gastonia, NC)
- …to MCO via fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments, ... liaison to managed care organizations. Communicates with attending physicians regarding utilization issues. Collaborates with discharge planning specialist and… more
- Motion Recruitment Partners (Durham, NC)
- Utilization Management Specialist Durham, NC **100% Remote** Contract $17/hr - $17/hr Our client, a nationally recognized and award-winning company in the ... health insurance vertical, has a contract opening for a Utilization Management Specialist . They have...Healthcare background **What You Will Be Doing** *Conducts non clinical reviews based on applicable criteria and guidelines on… more
- Munson Healthcare (Traverse City, MI)
- …of Michigan. + Minimum of three years clinical experience required. Previous utilization review and/or case management in a hospital or insurance industry ... + Assists in developing and revising policies to support utilization management activities, including criteria and guidelines...payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? +… more
- BayCare Health System (Clearwater, FL)
- …and more Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review Specialist Senior **Location** Clearwater | Clinical | Part Time **Req ... and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and compassionate… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
- Veterans Affairs, Veterans Health Administration (San Juan, PR)
- Summary The Supervisory Acquisition Utilization Specialist renders expert contract pre-award and post award expertise to all Administrative and Clinical ... not a virtual position. Position Description/PD#: Supervisory Acquisition & Utilization Specialist /PD99867A Relocation/Recruitment Incentives: Not Authorized Critical… more
- Sutter Health (Berkeley, CA)
- …systems for the appeal/denial process, tracks and trends data, and coordinates utilization management activities for the assigned area. Collaborates with ... clinical nursing staff and others to ensure appropriate utilization and quality care through utilization review,...revisions to operational procedures. + Collaborate with case managers, clinical management , clinical nursing staff… more
- Veterans Affairs, Veterans Health Administration (North Charleston, SC)
- Summary As the Acquisition Utilization Specialist you will serve as the medical center liaison and advisor on contract related services focusing on critical ... clinical and healthcare services, product acquisition and support services...is not a virtual position. Position Description/PD#: Acquisition & Utilization Specialist /PD07899A Relocation/Recruitment Incentives: Not Required Requirements… more
- Reno Behavioral Healthcare Hospital (Reno, NV)
- …an interdisciplinary approach to support continuity of care. + Provides utilization management , transfer coordination, discharge planning, and issuance of ... The UR Specialist reviews and monitors patients' utilization ...and quality of care. + Responsible for the proactive management of patients with the objective of improving quality… more
- Veterans Affairs, Veterans Health Administration (IN)
- Summary The VA Northeast Ohio Healthcare System is recruiting for an Acquisition Utilization Specialist . This position will function in Logistics Service. ... Virtual: Remote 100% Within Area. Position Description/PD#: Acquisition & Utilization Specialist /PD99810S Relocation/Recruitment Incentives: Not Authorized Permanent… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... Resource Management issues, other issues including concerns involving under/over utilization , avoidable days and quality issues. 13. Responsible for all incoming… more
- Commonwealth Care Alliance (Boston, MA)
- …operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized clinical review and authorization ... area of service decisions and organizational determinations.The Manager, Utilization Management reports to the Director of Clinical Effectiveness. **What… more
- Trinity Health (Pontiac, MI)
- …customers and community groups. **D.** **Experience** Three years recent acute care utilization management experience. Knowledge of regulations relative to ... licensure within the State of Michigan. Certified Professional in Utilization Review/ Management preferred. **C** **Special Skill /...the appeal process when deemed necessary by the Denials Management Specialist on cases where payment has… more
- HCA Healthcare (Dallas, TX)
- …includes monitoring patient medication regimens and providing appropriate interventions. The Clinical Specialist shall also assist in mentoring pharmacy staff ... **Description** ** Clinical Pharmacist Specialist BMT** **BMT Experience...defined by Pharmacy Leadership. Develop, manage and mentor antimicrobial management program (AMP). + Documents all clinical … more
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