- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** **The Utilization Review Physician collaborates with the healthcare team in the** **management and resolution of activities that assure the ... patient status determinations - OBS vs. Inpatient** **c. Liaison to the Medical Staff supporting Utilization Management Committee processes** **d. Hospital Based… more
- Hackensack Meridian Health (Hackensack, NJ)
- …patient status determinations - OBS vs. Inpatient c. Liaison to the Medical Staff supporting Utilization Management Committee processes d. Hospital Based ... leadership to support, and provide assistance and support in overall medical management effectiveness, benchmarked utilization and cost management (UM)… more
- Trinity Health (Boise, ID)
- …Saint Alphonsus is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This position will be ... Ability to work with Trinity Health experts in managing and developing medical utilization programs and documentation initiatives. **Work Experience** **Job… more
- Sharp HealthCare (San Diego, CA)
- …other members of the health care team as well as the respective medical groups to facilitate the utilization management process.Identify and refers situations ... Manager, Physician Advisor, as appropriate.Participate in system or site-level utilization review activities and projects as needed.Maintain a log and report of… more
- Sharp HealthCare (San Diego, CA)
- …other members of the health care team as well as the respective medical groups to facilitate the utilization management process.Identify and refers situations ... Manager, Physician Advisor, as appropriate.Participate in system or site-level utilization review activities and projects as needed.Maintain a log and report of… more
- The County of Los Angeles (Los Angeles, CA)
- … direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one ... hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty...utilization review standard. Under the direction of a physician member of the Utilization Review Committee,… more
- Munson Healthcare (Traverse City, MI)
- …colleagues and hospital associates at information meetings. + May represent Utilization Management on various committees, professional organizations, physician ... based on documented condition plan of treatment and care. + Supports physician decision-making by coaching on appropriateness of inpatient or observation status. +… more
- Beth Israel Lahey Health (Boston, MA)
- …difference in people's lives.** Position Summary: In conjunction with the admitting/attending physician , the Utilization Review RN assists in determining the ... level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria… more
- UNC Health Care (Chapel Hill, NC)
- …the Utilization Manager is responsible for revenue protection by reconciling physician orders, bed billing type, and medical necessity. This may include ... Advisor as necessary to resolve barriers through appropriate administrative and medical channels. 4. Utilization Outcomes Management - Monitors and guides… more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management ... consultation to the leadership and staff who perform the functions of Utilization Management (UM), Case Management (CM), Transition Planning/ Discharge Planning, and… more
- Sutter Health (Berkeley, CA)
- …to justify acute hospital admission, need for continued stay, and proper utilization of physician , nursing, and ancillary services. Responsible for concurrent ... clinical nursing staff and other departments regarding documentation required for utilization review activities and processes. Collaborate with medical , nursing… more
- Hackensack Meridian Health (Neptune, NJ)
- …insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + Obtains and evaluates ... and serve as a leader of positive change. The **Care Management, Care Coordinator, Utilization Management** is a member of the healthcare team and is responsible for… more
- Hackensack Meridian Health (Holmdel, NJ)
- …insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + Obtains and evaluates ... healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management** is a member of the healthcare team and is responsible for… more
- Community Health Systems (Franklin, TN)
- …and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for admission to ... admission, and better be able to request appropriate additional documentation from the physician (s). + Escalates cases to the Utilization Review Manager and/or … more
- Lawrence General Hospital (Lawrence, MA)
- …under supervision and in collaboration with the Utilization Review Coordinator, Utilization Review Nurses, Physician advisor and healthcare team supports all ... administrative tasks/responsibilities for utilization management and revenue integrity cycle processes. Interacts directly and indirectly with internal and external… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …BCBSMA utilization management process + Collaborate with members/families, providers, medical staff and/or other members of the treatment team to coordinate and ... transform healthcare? Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care for members who may have… more
- Catholic Health Services (Melville, NY)
- …from payors for additional clinical documentation. | Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as ... hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the… more
- Community Health Systems (Franklin, TN)
- …efficiency of medical services and procedures in a Behavioral Health setting. Utilization review is the assessment for medical necessity, both for admission ... admission, and better be able to request appropriate additional documentation from the physician (s). + Escalates cases to the Utilization Review Manager and/or … more
- Fairview Health Services (St. Paul, MN)
- **Overview** **Fairview Health Services is hiring a casual** ** Utilization Management Spec RN** **to join our Revenue Cycle Management team. This is a remote ... Description** **Job Expectations:** + Perform and document timely and accurate utilization management review to ensure compliance with all policies, procedures,… 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 within a ... management of: + Program-specific applications, quality improvement, staff education, medical records, and internal and external regulatory and survey requirements.… more