- WellSpan Health (York, PA)
- Director - Utilization and Denials Management Location: WellSpan Health, York, PA Schedule: Full Time General Summary Supervises and oversees the ... the System. Duties and Responsibilities + Oversees the utilization management process for preauthorization, concurrent review, denials and appeals for… more
- Kaleida Health (Buffalo, NY)
- …and tactics to successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan and, assists in the ... 72111BR **Department:** 24068 - Clinical Revenue Cycle Admin **Job Description:** The Director , Clinical & DRG Denials provides clinical leadership and… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …resources to help you flourish and leaders who care about your success. The Utilization Management (UM) Director is responsible for the market(s) ... development, implementation, evaluation and direction of the Utilization Management Program and staff in support of the CommonSpirit Health Care Coordination… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/172723/corporate- director -of-clinical- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
- Billings Clinic (Billings, MT)
- …leadership and Physician Advisor, per department process or procedure Insurance and Utilization Management Maintains working knowledge of CMS requirements and ... - 44.18 Under the direction of department leadership, the Utilization Review/ Management RN. This position is...to Case Manager on current outliers, potential outliers, and denials Identifies reviews that need to be completed on… more
- AdventHealth (Daytona Beach, FL)
- …Parkway, Daytona Beach, FL 32117 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise ... three years acute care clinical nursing experience + Minimum two years Utilization Management experience + Excellent interpersonal communication and negotiation… more
- Huron Consulting Group (Chicago, IL)
- …the utilization management system. + Generate and analyze reports on utilization trends, denials , and appeals to identify areas for improvement. + Ensure ... you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring... processes and patient care outcomes. + Lead UM Denials Team Meetings to address denial management … more
- Stanford Health Care (Palo Alto, CA)
- …with the UM/CM Medical Director on strategic issues involving Utilization Management Department programs. + Collaborates with Physician Advisory Services ... the UM/CM Medical Director team on complex cases. + Ensures Utilization Management staff maintains up-to-date knowledge, skills, and abilities related to… more
- Guthrie (Sayre, PA)
- …but strong needs for clinical knowledge to leverage payors. Position Summary: The Utilization Management (UM) Reviewer, in collaboration with other internal and ... payors, and providers and staff, is responsible for the coordinates Utilization Management (UM) processes and requirements for prior authorization/certification… more
- Trinity Health (Silver Spring, MD)
- …acute healthcare setting required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At least 5-7 years ... + Full-Time 8am - 4:30pm + Reporting to the Director of Care Management + The RN...while supporting the HCH mission. + Assists with the denials prevention and management staff to ensure… more
- Brockton Hospital (Brockton, MA)
- PURPOSE OF POSITION: The Director of Case Management is responsible for planning, directing, and managing of the activities of the Case Management Program ... solves problems, referring exceptional issues to Vice President. The Director of Case Management is responsible for...enhances the quality of patient care while optimizing resource utilization . Provides training to staff on case management… more
- BronxCare Health System (Bronx, NY)
- Overview Assists in the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care ... and implementation of educational programs for Denial Prevention and Management . Responsibilities - Establish and maintain positive relationships with patients,… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …third party payers and communicate potential or identified concerns to the treatment team, Director of Utilization Management , and the Medical Director . ... transform healthcare and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of behavioral… more
- Monte Nido (Miami, FL)
- …+ Understanding of Medicare medical necessity criteria; consult with Admissions staff and Director of Utilization Management on all evaluations for Medicare ... providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been delivering… more
- Hartford HealthCare (Torrington, CT)
- …Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the IP Psychiatry Patient ... Care Team to assure Utilization Review activities on a 17 bed Adult unit....secure reauthorization for care; and follow up on insurance denials . Requires in-depth knowledge of behavioral health services in… more
- AdventHealth (Maitland, FL)
- …The Medical Director is responsible for providing physician review of utilization , claims management , and quality assurance related to inpatient care, ... assigned by the Division CFO/SrVP, Vice President of Revenue Cycle Operations and/or Director , Utilization Review Management ..Reviews data and trends to… more
- Acacia Network (Bronx, NY)
- …degree required (Bachelor's Degree preferred) + Minimum of 2 years of case management and/or utilization review experience + Strong problem-solving and advanced ... Acacia Network Inc. Utilization Manager Bronx, : 5/30/2024 Job Description Job...identifying and referring requests for services to the Medical Director when guidelines are not met and reviewing residential… more
- Penn Medicine (Plainsboro, NJ)
- … management of the continuum of care process, length of stay, denials management , and status of patients. The Director serves as the primary point of ... monitoring of the outcomes of the Care Management staff (Case Managers, Utilization Managers, Physician Advisors and Denials Coordinators). The Director … more
- The Mount Sinai Health System (New York, NY)
- …of comprehensive front-line Case Management services, including utilization management , care facilitation and discharge planning. The Director works with ... **JOB DESCRIPTION** The Director of Case Management is responsible... management is preferred Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West… more
- Houston Methodist (Cypress, TX)
- …identification of opportunities for appropriate utilization of resources to avoid denials and resource management as it pertains to delivery of care. ... and trends in the areas of care coordination, evidence- based practice, utilization management , and service excellence. Disseminates information and focuses the… more