- NewYork-Presbyterian (Brooklyn, NY)
- …efficiency and quality, and ensuring resource utilization is appropriate. Case manager / utilization manager : Responsible for an average of 60-70 ... will need are listed in the following description. Case Manager - RN - Inpatient Units- Brooklyn Methodist -...is responsible for all aspects of discharge planning and utilization management/ review for an assigned group of… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... RN Case Manager **Position Summary** At Stony Brook Medicine, a...cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to… more
- Beth Israel Lahey Health (Plymouth, MA)
- …you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding UR… more
- Hartford HealthCare (Farmington, CT)
- …practices. *_Position Responsibilities:_* *Key Areas of Responsibility* *Denial Resolution* . Review DRG validation denials from payers, analyze the denial ... The Denial Specialist 2 is responsible for reviewing, analyzing, and appealing denials related to DRG (Diagnostic Related Group) validation denials . This… 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 ... respond to all concurrent and post-discharge third party payer denials of outpatient and inpatient cases alleged to be...required or completed within three years of hire **Title:** * Manager - Utilization Review * **Location:**… more
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the...Performance Tracking and Improvement: Provides analysis and reports of utilization , denials , and appeals KPIs, trends, patterns,… more
- Community Health Systems (Franklin, TN)
- …Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals activities. ... timely authorizations and reduce potential denials , utilizing input from the Utilization Review Clinical Specialist. + Monitors and updates case management… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... this position is able to cover a multitude of utilization review functions through point of entry,...plan of care and ensures prompt notification of any denials to the appropriate case manager , … more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review - Case Management - 2506004107 Description : Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse ... level of care, length of stay and authorization Prevents denials and disputes by communicating with payors and documenting...level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... the supervisor including but not limited to processing concurrent denials . + Preferred experience includes Critical Care or Emergency...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- Sharp HealthCare (San Diego, CA)
- …every patient identified per departmental guidelines during hospital stay beginning with the admission review of the case manager and reviews with the Case ... care, SNF, home health, or hospice settings. + Experience as a case manager or discharge planner interacting with managed care payers. + Experience with InterQual… more
- South Middlesex Opportunity Council (Framingham, MA)
- …individuals, children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. ... fashion, for the RRS and outpatient clinic programs. + Review denials and partially paid claims and...As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or incidental contact… more
- Houston Methodist (Katy, TX)
- …Audit, Business Practices, Health Information Management, Patient Access Services, and Utilization Review as needed to ensure operational billing compliance ... At Houston Methodist, the Manager Revenue Cycle position is responsible for the...to: medical coding, insurance billing, collections, patient account resolution, appeals/ denials , customer service, cash applications, revenue integrity, etc. This… more
- Sharp HealthCare (San Diego, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... medical record and provides information to the department head as indicated. + Utilization review and utilization managementThe RN CM I will:Conduct… more
- BronxCare Health System (Bronx, NY)
- …for the staff on identified deficiencies to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely ... and department staff when prevented from completing job tasks. -Assists the Administrative Manager and Director with annual review and revisions of departmental… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …medical staff and take on the role as leader of the Hospital's utilization review /management committee, which is charged with adhering to regulatory requirements ... Commercial Payors, as needed * Reviews medical records of patients identified by case managers/ utilization review nurses, or as requested by other members of the… more
- Eastern Connecticut Health Network (Manchester, CT)
- POSITION SUMMARY: The Utilization Review Case Manager (UR CM) works in collaboration with the physician and interdisciplinary team to support the underlying ... in the acute-care setting. + Minimum of 1 year Utilization Review experience preferred via industry clinical...and status on all patients through collaboration with Case Manager . + Demonstrates thorough knowledge in the application of… more
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