- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... discounts and more Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review RN **Location** Tampa:St Josephs | Clinical | PRN **Req… more
- Community Health Systems (Franklin, TN)
- …information to secure timely authorizations and reduce potential denials, utilizing input from the Utilization Review Clinical Specialist . + Monitors and ... **Job Summary** The Utilization Review Coordinator ensures efficient and...activities. This role collaborates with payers, hospital staff, and clinical specialists to secure timely authorizations for hospital admissions… more
- Deloitte (Los Angeles, CA)
- …registered nurse, physician, physician assistant, case manager, clinical documentation specialist , utilization review , informatics RN, Quality, DRG ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk… more
- Spectrum Billing Solutions (Skokie, IL)
- …Excel, billing software). + Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management ... will utilize his or her knowledge and skills to review clinical information and obtain initial and... | UR Specialist | Revenue Cycle Utilization Review Specialist | ABA… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is ... responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients...and advocating for appropriate levels of care. The UR Specialist works closely with clinical staff, admissions,… more
- Hackensack Meridian Health (Hackensack, NJ)
- **The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of ... and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and transitions… 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 ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Penn Medicine (Lancaster, PA)
- …Medicine Lancaster General Health is looking for an experienced RN to join our Utilization Management Specialist team! In this critical role, you'll advocate for ... we'd love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible...Strong critical thinking skills and the ability to perform clinical chart review efficiently. Strong analytical, data… more
- AnMed Health (Anderson, SC)
- … clinical knowledge to independently review the medical record for clinical appropriateness and resource utilization including but not limited to : ... review , continued stay/concurrent review , retrospective review , bed status management, resource utilization management,...patient acuity and related clinical services, applies approved medical necessity criteria for screening… more
- WestCare Foundation (Henderson, NV)
- …LPN or RN and/or Bachelors or Masters level CADC/LADC with 2 years utilization review experience, preferred experience working with individuals with psychiatric ... Description Position Summary: Person in this position is responsible for collecting clinical information and communicating with MCOs in a timely manner in order… 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 clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing stay.… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional Care Team.This is a full-time role and will be required to work ... this position: *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include… more
- UnityPoint Health (Cedar Rapids, IA)
- …174223 Overview This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments ... optimal clinical outcomes and patient and provider satisfaction. The UM Specialist provides the Utilization Management function for patients admitted to BH… more
- St. Peters Health (Helena, MT)
- The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN supports the UR RN Coordinator and other UR team members in ... providing all identified utilization review functions for the organization to...admission status and confirm treatment goals, treatment plan, and clinical mileposts used to advance the treatment plan. 12.… more
- UNC Health Care (Kinston, NC)
- …on status of at-risk dollars and appeal win rates. 12. Assists in documentation review in the clinical documentation specialist role when needed. Working ... documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by...on assigned Hospital Units. 13. Works closely with the Clinical Documentation Specialist Lead to develop provider… more
- UPMC (Bridgeville, PA)
- UPMC Rx Partners is looking for a full time Pharmacy Clinical Review Specialist to join their dedicated team! This position provides prescription data entry ... to Rx Partners Skilled nursing and Hospice clients. The clinical review specialist at Rx...of benefits, complaints and grievance guidelines and prescription drug utilization management required + Thorough knowledge in MS Office… more
- HCA Healthcare (Dallas, TX)
- …compelling, we encourage you to apply for our Clinical Pharmacist Specialist BMT opening. We promptly review all applications. Highly qualified candidates ... includes monitoring patient medication regimens and providing appropriate interventions. The Clinical Specialist shall also assist in mentoring pharmacy staff… more
- SSM Health (Jefferson City, MO)
- …promoting rational, safe, and cost-effective drug therapy by developing and providing clinical services in their area of expertise. Conducts drug therapy monitoring, ... pharmaceutical care in their specialty practice area which may include: review and evaluation of patient drug/medical history, providing drug therapy recommendations… more
- Northwell Health (New Hyde Park, NY)
- …responsible for the development, implementation, and maintenance of drug formularies, clinical utilization management (UM) criteria, and evidence-based drug ... to match formulary intent. This role involves critical evaluation of clinical literature, pharmacoeconomic data, and regulatory requirements to support P&T Committee… more
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