- 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 ... of hospital resources, and continued stays of inpatients. The Medical Director of utilization review will ensure the most efficient use of the… more
- UCLA Health (Los Angeles, CA)
- …communication is provided to all stakeholders. + Working closely with medical director , utilization management and quality review team to ensure that ... Description As the Utilization Management & Quality Review Specialist, you will be responsible for: + Managing service requests and potential quality issue… more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization ... Management programs at AnMed. The Medical Director ensures the program and associated physicians work collaboratively with and provide consultation to the… more
- St. Luke's University Health Network (Allentown, PA)
- …and/or physician queries + Serves as liaison between Physician Advisor/ Medical Director , Finance, Utilization Review Department and CDCI. PHYSICAL AND ... Conducts reviews of cases lost with feedback to respective departments + Conduct concurrent review with utilization review department for post op surgical… more
- Trinity Health (Boise, ID)
- …**Job Description:** Saint Alphonsus is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This position ... annually by the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization...patients not meeting inpatient criteria. C. Participates in local Utilization Review Committee and be a member… more
- Ascension Health (Nashville, TN)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured clients to ... throughout the TN market. We're looking for an experienced Director of Utilization Management to join our...16 hospitals and a network of affiliated joint ventures, medical practices, clinics and specialty facilities. Across the state,… more
- Prime Healthcare (Ontario, CA)
- …Clinical Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according ... needs. + Provides strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with… more
- Ascension Health (Tulsa, OK)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to ... professional licensure at time of hire. **Additional Preferences** + Strong Utilization Review experience + Exceptional communication skills + Leadership… more
- Covenant Health Inc. (Louisville, TN)
- Overview Utilization Review Coordinator, Quality Management Full Time, 80 Hours Per Pay Period, Day Shift Peninsula Overview: Peninsula, a division of Parkwest ... and authorizes sessions per guidelines. + Works collaboratively with Medical Director and accesses consultation and involvement...or retrospective utilization data. + Monitors current utilization review criteria and length of stay… more
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review , under the supervision and in collaboration with the ... Director , is responsible and accountable for the operational management,...activities of hospital staff in inpatient care coordination and utilization review . Oversees interactions of staff with… more
- Behavioral Center of Michigan (Warren, MI)
- Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex ... and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart...all tasks requested by the UR Manager, CEO or Medical Director to meet the needs of… more
- 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
- Hackensack Meridian Health (Belle Mead, NJ)
- …concerns to the treatment team, Director of Utilization Management, and the Medical Director . + Review charts at identified review points and ... 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
- 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...DRU 3 Team Lead writes appeal letters using UR medical directors and the medical team for… more
- Martin's Point Health Care (Portland, ME)
- …requests (prior authorization, concurrent review , and retrospective review ) for medical necessity referring to Medical Director as needed for ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member...Utilize evidenced-based criteria, governmental policies, and internal guidelines for medical necessity reviews. + Manage the review … more
- Covenant Health (Nashua, NH)
- …health care team. + Annual goals are achieved. + Attends pertinent case management/ utilization review programs to maintain current knowledge of UR practices. + ... medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed...+ Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Utilization Review Clinical Review (CR) 3 Team Lead will assist the Director of UR and Associate Director of UR with daily staff ... of service for admission and continued stay at the time of medical record screening. Responds to Managed Care/Insurance Company inquiries regarding admission,… more
- Reno Behavioral Healthcare Hospital (Reno, NV)
- …care issues with the Director of Clinical Services and Chief Medical Officer/ Medical Director as appropriate. + Coordinates an interdisciplinary ... of maintaining high quality, cost-effective care. The duties include providing the medical and utilization expertise necessary to evaluate the appropriateness… more
- Stanford Health Care (Palo Alto, CA)
- …and Abilities** + Knowledge of principles and best practices of case management, utilization review , social work, care coordination and discharge planning. + ... Health Care (SHC)? - Recognized as a top Academic Medical Center globally! - Ranked No. 10 on the...leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- POSITION TITLE: Utilization Review Clinician REPORTS TO (TITLE): Director of Utilization Review DESCRIPTION OF POSITION: Work as member of ... to third party payers. + Recordkeeping: Maintains appropriate records of the Utilization Review Department. + Training: Provide staff in-service training and… more
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