- CaroMont Health (Gastonia, NC)
- …MCO, Medicare, or RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of ... medical necessity will be performed and documented in medical review , including daily status update while...NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case… 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
- Spectrum Billing Solutions (Skokie, IL)
- …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing...want to promote within our team. + Benefits - Medical , Dental, Vision + Flexible Paid Time Off -… more
- St. Luke's University Health Network (Allentown, PA)
- …incorrect registrations and/or physician queries + Serves as liaison between Physician Advisor/ Medical Director, Finance, Utilization Review Department and ... Conducts reviews of cases lost with feedback to respective departments + Conduct concurrent review with utilization review department for post op surgical… more
- The Cigna Group (Bloomfield, CT)
- …Must be able to research clinical issues on internet resources. - Experience in medical management, utilization review and case management in a managed ... medical research to ensure the quality of the medical care provided to patients. Implements utilization ... trends. Requires an MD or DO. SUMMARY: The Medical Principal performs medical necessity review… more
- Beth Israel Lahey Health (Burlington, MA)
- …a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in Burlington Hospital ... hospital staffs. -Case Manager experience as well as Utilization Review experience ( review medical necessity and discharge planning) **As a health care… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …identified 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
- Dignity Health (San Bernardino, CA)
- …for more information. **Responsibilities** The Utilization Review Specialist is responsible for reviewing medical ... guidelines and critical thinking to support patient care and optimize resource utilization . **Key Responsibilities:** + Review medical records to… more
- Medical Mutual of Ohio (OH)
- …in a healthcare environment.** **Technical Skills and Knowledge** + Knowledge of medical terminology, utilization review processes and awareness of ... Founded in 1934, Medical Mutual is the oldest and one of...general supervision,** **performs administrative functions in support of assigned utilization review or case management department. Receives… 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
- 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
- G-TECH Services, Inc. (Detroit, MI)
- …Degree or nursing diploma required, Triage, case management or utilization review experience, Expertise in the use of medical terminology, InterQual ... Optional but preferred skills/experience. Include: * Utilization Review experience at a previous insurance company ( medical... Review experience at a previous insurance company ( medical , surgical admissions) * Utilization Review… 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
- Medical Mutual of Ohio (OH)
- …area of billing and coding, medical records, quality assurance, or utilization review .** **Professional Certification(s):** **.** ** Medical Technology or ... in the area of billing and coding, medical records, quality assurance or utilization review , at least 2 years of which is as a Medical Record Retrieval… more
- G-TECH Services, Inc. (Detroit, MI)
- …Skills/Experience - Optional but preferred skills/experience. Include: * Utilization Review experience at a previous insurance company ( medical , surgical ... which may include acute patient care, discharge planning, case management, and utilization review with another insurance provider, etc. Demonstrates clinical… more
- CareFirst (Baltimore, MD)
- … medical -surgical or similar clinical experience OR + 5 years experience in Medical Review , Utilization Management or Case Management at CareFirst ... resolution of appeals and reconsiderations, including Regulatory complaints and External review requests. Accountable for quality review and interpretation of… more
- Medical Mutual of Ohio (OH)
- …the area of billing and coding, medical records, quality assurance, or utilization review . . Medical Technology or Health Information Technology ... in Ohio. Note: quarterly in-office requirement in Brooklyn, Ohio._** Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies… more
- Robert Half Accountemps (Lauderdale Lakes, FL)
- …* Experience: o At least 1-2 years of experience working with clinical records, medical documentation, or utilization review , preferably in ABA therapy, ... required. o Familiarity with regulatory compliance standards, payer requirements, and utilization review processes. o Excellent organizational and time… 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 $118,161.60 - $176,872.80 Annually… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
Related Job Searches:
Medical,
Medical Director Utilization Review,
Medical Review,
Medical Utilization Review Nurse,
Medical Utilization Review Physician,
Medical Utilization Review Travel,
Review,
Utilization,
Utilization Review