• Executive Medical Director Revenue Cycle

    AdventHealth (Maitland, FL)
    …as assigned by the Division CFO/SrVP, Vice President of Revenue Cycle Operations and/or Director , Utilization Review Management ..Reviews data and trends ... review of long stay patients, in conjunction with the Director of Utilization Review Management to facilitate the use of the most appropriate level of… more
    AdventHealth (11/04/24)
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  • Medical Director of Utilization

    Henry Ford Health System (Detroit, MI)
    The Medical Director of Utilization Review is responsible for the medical oversight of activities related to appropriateness of Henry Ford Hospital (HFH) ... hospital resources, and continued stays of inpatients. The Medical Director of utilization review will...Ensure correct patient status for hospitalized patients 3. Chair Utilization Management Committee: a. Reviewing outlier data,… more
    Henry Ford Health System (11/06/24)
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  • Utilization Management

    CareFirst (Baltimore, MD)
    …location based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the ... Hire Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience. **Preferred Qualifications:** +… more
    CareFirst (11/26/24)
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  • Market Director of Utilization

    Ascension Health (Nashville, TN)
    …to Ascension Saint Thomas hospitals throughout the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this ... **Details** + **Department:** Utilization Management + **Schedule:** Monday -...Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured… more
    Ascension Health (10/25/24)
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  • Medical Director : Documentation…

    Trinity Health (Boise, ID)
    …of two years' experience in hospital based medicine with exposure to utilization management and documentation initiatives. 3. Demonstrated teamwork, performance ... MDDUE will work in a dyad partnership with the Director of Clinical Resource Management . This position...patients not meeting inpatient criteria. C. Participates in local Utilization Review Committee and be a member… more
    Trinity Health (10/14/24)
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  • Corporate Director of Clinical…

    Prime Healthcare (Ontario, CA)
    …Responsibilities The Corporate Director of Clinical ... Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according to… more
    Prime Healthcare (11/28/24)
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  • Medical Director - Utilization

    AnMed Health (Anderson, SC)
    The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management ... to the leadership and staff who perform the functions of Utilization Management (UM), Case Management (CM), Transition Planning/ Discharge Planning,… more
    AnMed Health (10/22/24)
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  • RN Registered Nurse Director

    Ascension Health (Tulsa, OK)
    **Details** + **Department:** Utilization Management + **Schedule:** FT, Monday-Friday, 8am-5pm + **Hospital:** Ascension St. John Medical Center + **Location:** ... Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan. Responsibilities: +… more
    Ascension Health (11/21/24)
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  • Interim Manager - Case Management

    Trinity Health (Silver Spring, MD)
    **Employment Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review , under the supervision and in ... /supervision/leadership experience in an acute healthcare setting required, preferably with case management , utilization review or closely related area. +… more
    Trinity Health (10/10/24)
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  • UM Coordinator - Utilization Review

    Hackensack Meridian Health (Belle Mead, NJ)
    …treatment team, Director of Utilization Management , and the Medical Director . + Review charts at identified review points and attend treatment ... of resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of care and promoting… more
    Hackensack Meridian Health (10/28/24)
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  • Utilization Review Coordinator

    Behavioral Center of Michigan (Warren, MI)
    Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex ... clinical data and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart and records clinical… more
    Behavioral Center of Michigan (10/22/24)
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  • Utilization Review Manager-Selikoff…

    Mount Sinai Health System (New York, NY)
    **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
    Mount Sinai Health System (10/31/24)
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  • Manager, Care Coordination - Utilization

    Stanford Health Care (Palo Alto, CA)
    …Skills and Abilities** + Knowledge of principles and best practices of case management , utilization review , social work, care coordination and discharge ... practice. Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation,… more
    Stanford Health Care (11/20/24)
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  • Utilization Review Denials…

    SUNY Upstate Medical University (Syracuse, NY)
    Review Denials Review Unit (DRU) 3 Team Lead will assist the Director of Utilization Review and the Associate Director of Utilization ... and provides feedback/mentorship to UR CR I as to review , payor and regulatory questions. This UR DRU 3...nursing experience required. Minimum of 1 year of denial management experience with progressive proficiency and autonomy of reviews… more
    SUNY Upstate Medical University (11/04/24)
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  • RN- Utilization Management

    ERP International (Nellis AFB, NV)
    … Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); Comprehensive Accreditation ... No Call, No Weekends, No Holidays! **Job Specific Position Duties:** * Provides Utilization Management activities and functions by using MTF specific Quality… more
    ERP International (11/02/24)
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  • Utilization Review Specialist

    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 of health care services with the goal...and quality of care. + Responsible for the proactive management of patients with the objective of improving quality… more
    Reno Behavioral Healthcare Hospital (11/13/24)
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  • Utilization Review Nurse

    US Tech Solutions (Columbia, SC)
    …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management /clinical/or combination; 2 of ... prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. +… more
    US Tech Solutions (10/31/24)
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  • SRS-Inpatient Case Manager II - Utilization

    Sharp HealthCare (San Diego, CA)
    …experience or case management experience + 3 Years recent case management , utilization review , care coordination experience + California Registered ... position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving… more
    Sharp HealthCare (10/30/24)
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  • Utilization Management RN

    HCA Healthcare (Campbell, CA)
    …and personal growth, we encourage you to apply for our Utilization Management RN opening. We promptly review all applications. Highly qualified candidates ... midpoint of the range. **Introduction** Do you have the career opportunities as a(an) ** Utilization Management RN** you want with your current employer? We have… more
    HCA Healthcare (11/27/24)
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  • Utilization Management Nurse…

    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
    LA Care Health Plan (11/09/24)
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