- Altru Health (Grand Forks, ND)
- …Work situations are varied, requiring broad-based clinical expertise, knowledge of medical products, strong leadership skills, including discretion, the ability to ... Management to achieve cost savings by focusing on appropriate supply standardization, utilization , and process improvements to seek high quality and cost effective… more
- Saint Francis Health System (Tulsa, OK)
- …of adverse physiological trends, assurance of appropriate prophylactic strategies, and medical chart review . Virtually evaluates patients, educates the patient ... an on-site office location (not a remote position)Will perform admit, discharge chart review and other patient care duties from an office location via secure virtual… more
- Saint Francis Health System (Tulsa, OK)
- …psychosocial factors. Documents steps of the nursing process. Utilizes proper medical terminology. Addresses problems and progress toward goals. Facilitates patient ... discharge through timely, appropriate referrals and utilization of patient education resources, suitable to patient age and cultural/psychosocial factors.… more
- Martin's Point Health Care (Portland, ME)
- …to support accurate medical necessity and dispute decisions. + Partners with Medical Directors, Utilization Review Team, Provider Inquiry, and Claims ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member... outcomes. Job Description Key Outcomes/Results: + Manages the review of medical claims disputes, records, and… more
- Health First (Melbourne, FL)
- *POSITION SUMMARY* The Utilization Review (UR) nurse performs medical necessity reviews on all payer admissions to determine appropriate admission status and ... require use of personal vehicle. **Job:** **Case Management* **Organization:** **Holmes Regional Medical Center* **Title:** * Utilization Review Nurse - Case… more
- Beth Israel Lahey Health (Burlington, MA)
- … necessity recommendations, as requested Policy Setting Responsibilities Responsible for utilization review and medical necessity recommendations, as ... compliance with responsibilities. Supervisory Responsibility: Responsible for engaging physicians in utilization review and medical necessity activities Key… more
- Spectrum Billing Solutions (Skokie, IL)
- …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing...+ Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment. +… more
- CDS Life Transitions (Webster, NY)
- …to the position as assigned by supervisor. + Acts as Subject Matter Expert in Utilization Review and medical necessity criteria + Continually maintain clear, ... Summary: Utilization Management Reviewer (UR) is the critical evaluation...medical necessity of those services + Compile and review the necessary documents and clinical records to effectively… more
- Intermountain Health (Las Vegas, NV)
- …by UM Medical and Operational Leadership. Job Profile: + Trains and educates on medical review activities pertaining to utilization review , claims ... review , quality assurance, and medical review of complex, controversial, or experimental medical ...criteria, and state, local, or federal guidelines relating to utilization management. + Demonstrated knowledge of case management, … more
- Beth Israel Lahey Health (Burlington, MA)
- … and hospital staffs. -Case Manager experience as well as Utilization Review experience ( review medical necessity and discharge planning) **FLSA ... States of America) Joint role of Case Manager and Utilization Review Nurse Hospital at Home Full...post acute care Services. 15) Participates in hospital or medical committees representing patient issues and department functions such… more
- Southeast Health (Dothan, AL)
- Southeast. Always the right career direction. Job Description Summary The Utilization Review Nurse screens medical records in accordance with contractual ... agreement and regulatory requirements for medical necessity on admission and continued stay in the...(3) years acute care experience + One (1) year utilization review experience Required Skills/Abilities + Demonstrates… more
- Lancaster General Health (Lancaster, PA)
- …to clinical services provided by the Hospitalists, quality improvement, education of staff, medical and utilization review and feedback, and support for ... **Summary** **Job Description** **POSITION SUMMARY:** The Associate Medical Director, Hospitalist Services is responsible for assisting the Medical Director,… more
- Nuvance Health (Danbury, CT)
- …The Physician Advisor will develop and maintain expertise in assessing inpatient medical necessity, utilization review and assignment of appropriate ... medical providers, case managers, and other staff regarding appropriate utilization review processes, correct status assignment, and necessary clinical… more
- The Cigna Group (Bloomfield, CT)
- … utilization and financial initiatives. Responsible for program execution and drives utilization review medical program management for specific clinical ... Description SummaryGuides the company on strategic Utilization Review decisions and provides medical advice that... Utilization Review decisions and provides medical advice that has a significant impact on strategic… more
- SUNY Upstate Medical University (Syracuse, NY)
- …patients, maintaining accurate attendance and therapy records. Interfaces with nursing, medical staff, utilization review social services, discharge ... progress through written and verbal reports and through documentation in the medical record. Plan and schedule patient therapy based on individual needs. Schedules… more
- CVS Health (Phoenix, AZ)
- …A1A clinical staff- Provide clinical expertise and business direction in support of medical management and utilization review programs through participation ... (work from home) role. Candidates can reside anywhere in the US. The Medical Director (MD) for Aetna One Advocacy is responsible for providing clinical expertise… more
- Sharp HealthCare (San Diego, CA)
- …all accounts in rep assignment or alpha split. Contact hospital departments such as Medical Records, Utilization Review or external review organizations ... all necessary attachments required for billing (ie hard copy authorizations, medical records. 18-1. 50-1. etc.).Assures billing compliance standards are metCheck DDE… more
- US Tech Solutions (Columbia, SC)
- …practices. + May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews ... sets/qualities: I would love to have someone with prior insurance/ utilization review experience but I know that...indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print...over the nursing staff engaged in utilization review activities at Los Angeles General Medical ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $113,309.04 - $169,609.20 Annually… more
- Sedgwick (Columbia, SC)
- …environment. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Accesses and assigns cases for medical case management, utilization review and clinical ... information to callers based on customer requests; triages telephone calls between utilization review , clinical consultation and telephonic case managers. +… more
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