- St. Mary's Healthcare (Amsterdam, NY)
- … by drafting appeals, negotiating with payers, or following up with payer utilization review departments in attempts of obtaining authorizations and claim ... with medical staff and care coordination leaders to ensure ongoing compliance with utilization review guidelines. * Collaborates with managed care department to… more
- St. Luke's University Health Network (Allentown, PA)
- …role is a Certified Medical Coder who ensures clean claim submission and timely review and resolution of coding related claim denials for professional services, ... after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications. The appeals process may include collaboration… more
- Spectrum Billing Solutions (Skokie, IL)
- …Excel, billing software). + Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management ... and continuing authorization for treatment services. + Manage authorization denials including referral for peer review . +... | UR Specialist | Revenue Cycle Utilization Review Specialist | ABA… more
- BayCare Health System (Cotton Plant, AR)
- …responsibility and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding ... and compassionate team. **The Utilization Review Specialist Senior responsibilities...Critical Care or Emergency Service **Facility:** BayCare Health System, Utilization and Denials Mgmt-MPH **Location:** **Morton Plant**… 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 ... patient population and HackensackUMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Sanford Health (Thief River Falls, MN)
- …$26.00 - $41.50 **Department Details** Come join our Behavioral Health team as a Utilization Review Specialist utilizing a team-based approach to patient ... on medical necessity, level of care, length of stay, and authorization denials for hospitalized patients. Understand and provide insight into evaluating current… 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
- Henry Ford Health System (Wyandotte, MI)
- …The support specialist is a support role crucial to the centralized Utilization Review team for time sensitive authorization tracking and resolution process. ... Responsible for obtaining and tracking approvals, denials , and additional information requests received from third party payers within the EMR. EDUCATION AND… more
- Mount Sinai Health System (New York, NY)
- …Beth Israel **Responsibilities** Responsible for all aspects of the concurrent review program, insurance certification, and authorization process for all Psychiatric ... by management) and for all aspects of the initial review on an as needed basis Develops rapport with...providers as well as regulatory agencies, as needed for Utilization Management activities Demonstrates the knowledge and skills necessary… more
- ProMedica Health System (Toledo, OH)
- The Payor Specialist is responsible for payor notification, and securing authorizations for all admissions systemwide. They receive and answer voicemail and process ... faxes sent by the payers which includes authorizations, denials and requests for more information. They also act as the resource for the department for all payer… 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
- Trinity Health (Pontiac, MI)
- …RN licensure within the State of Michigan. Certified Professional in Utilization Review /Management preferred. **C** **Special Skill / Aptitudes** Understanding ... utilization management experience. Knowledge of regulations relative to utilization review . Knowledge of Federal, State and...in the appeal process when deemed necessary by the Denials Management Specialist on cases where payment… more
- Kepro (AR)
- …Hygienist Reviewer to join our growing team. Summary Description The Dental Clinical Specialist is responsible for the Utilization Management and Utilization ... with expertise in this area. + If a secondary review is necessary, such as denials , appeals,...denials , appeals, and fair hearings, the Dental Clinical Specialist would ensure that cases are prepared, completed within… more
- St. Luke's University Health Network (Allentown, PA)
- …list + Identify buy and bill authorizations vs. delivery and document account accordingly + Review and follow up on authorization denials and claim denials ... to pay for health care. The Network Prior Authorization and Referral Specialist is responsible for the coordination of prior-authorizations and referral process for… more
- Tufts Medicine (Burlington, MA)
- …(ICU, ED, Critical Care, strong Med/Surg Specialty) or equivalent case management, utilization review , denials management, or progressive leadership in ... Specialist III is responsible for concurrent and retrospect review and analysis of the medical record to improve...indicators where indicated. 10. Collaborates with case management and utilization review team to ensure that documentation… more
- Hackensack Meridian Health (Neptune, NJ)
- …information, inclusive of free text fields, to support the case management, utilization review process. + Retrieves information for the Physician Advisors ... A day in the life of a **Care Coordination Specialist ** at **Hackensack Meridian** **_Health_** includes: ** Utilization ...+ Verifies admission and discharge date information. + Updates Utilization Review RN needed for payors. +… more
- Hackensack Meridian Health (Hackensack, NJ)
- …information, inclusive of free text fields, to support the case management, utilization review process. + Retrieves information for the Physician Advisors ... a leader of positive change. The Integrated Case Management Specialist performs selected services and functions related to insurance...discharge dates. + Enters LAD into EPIC. + Keeps Utilization Review RN current on updates needed… more
- Carle (Urbana, IL)
- … issues in appropriate locations, including but not limited to: case management/ utilization review software and the multidisciplinary plan of care document ... Clinical Transition Specialist RN - Weekend Program + Department: IP...well and has what they need for success. Initial utilization review for emergency room patients being… more
- Avera (Sioux Falls, SD)
- …to collect prior balances. + The Specialist also collaborates with the Utilization Review , Business Offce and the Patient Advocates to ensure proper ... for career growth. **Exciting opportunity to join Avera as an Insurance Specialist !** **_Position Highlights:_** + **Positive Work Environment:** Be part of an… more
- UCLA Health (Los Angeles, CA)
- …+ Knowledge in the functional operations of third party payors and utilization review agencies to expeditiously coordinate follow-up. + Interpersonal skills ... Description Under the direct supervision of the Revenue Integrity Specialist Manager, the Reimbursement Specialist Supervisor will assist with the direct support… more