- 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 ... patient population and HackensackUMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Billings Clinic (Billings, MT)
- …starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings Clinic ... - 44.18 Under the direction of department leadership, the Utilization Review / Management RN. This position is...criteria or OBS ≥ 24 hours Communicate with attending physician for OBS patients meeting medical necessity… 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)
- …identified concerns to the treatment team, Director of Utilization Management, and the Medical Director. + Review charts at identified review points and ... a case by case basis. Applies case management and utilization review principles in monitoring the delivery...of cases with questionable medical necessity to Physician Advisor for determination. + Review clinical… more
- UNC Health Care (Rocky Mount, NC)
- …in healthcare/ medical - acute care (acute hospital setting) + 0-2 healthcare/ medical - - utilization review (or other healthcare-related experience) ... Carolina license without sanctions)** Preferred Certifications & Licensures + Utilization Review or other applicable certification **Professional Experience… more
- R1 RCM (Pittsburgh, PA)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. **Title: Utilization Review Nurse** **Location: Hospital Client located in ... experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines...vary and some flexibility may be offered** As our ** Utilization Review Nurse** , you will help… 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 ... work with Trinity Health experts in managing and developing medical utilization programs and documentation initiatives. **Work...patients not meeting inpatient criteria. C. Participates in local Utilization Review Committee and be a member… more
- Trinity Health (Silver Spring, MD)
- …the activities of RN Case Managers for in inpatient care coordination and utilization review . Oversees interactions of staff with outside activities and agencies ... of Nursing experience in an acute healthcare setting. + Designation Changes and Utilization Review + Knowledge of pertinent regulatory, accreditation, public and… more
- McLaren Health Care (Bay City, MI)
- …management to expedite patient discharge. 4. Maintains current knowledge of hospital utilization review processes and participates in the resolution of ... Bi-Weekly Hours:** 0 **Position Summary:** In conjunction with the admitting/attending physician , the UR Specialist RN assists in determining the appropriate… more
- HonorHealth (Scottsdale, AZ)
- …communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation,… more
- Baptist Memorial (Memphis, TN)
- Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and appropriateness of healthcare services and treatment as ... prescribed by utilization review standards. The UR Nurse works...and appropriate care. Areas of work include status management, medical necessity reviews, verification of authorization, resource utilization… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …1. Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted ... for appropriate status determination. 2. Ensures compliance with principles of utilization review , hospital policies and external regulatory agencies, Peer… more
- Trinity Health (Maywood, IL)
- …office Join our small but mighty team to guide and manage Utilization Review and Management for the Loyola Physician Partners LPP) Health Plan, a delegated ... Director/Manager oversees the daily caseloads of the UR/UM teams. This includes utilization review of inpatient medical and behavioral health services to… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Review Admission Specialist (OR Scheduler), Operating Room Surgical Scheduling, Mount Sinai West - Full Time, Days** The ... Utilization Review Specialist coordinates scheduling of all...and operating roaom time. 7. Checks credentials system for physician 's delineation of privileges for equipment and/or procedures according… more
- MetroHealth (Cleveland, OH)
- …care by ensuring the appropriate level of care at the point of entry. The utilization review nurse will work on defined patient populations and is responsible ... **Location:** **METROHEALTH MEDICAL CENTER** **Biweekly Hours:** **72.00** **Shift:** **8a-430p** **The...skills. Preferred: Two years of experience with case management, utilization review . Physical Demands: May need to… more
- Stanford Health Care (Palo Alto, CA)
- … records to ensure the necessity and appropriateness of care provided. 3. Utilization Review : Conduct thorough utilization reviews, applying evidence-based ... actions and provide feedback to prevent future denials. + Review medical records to ensure complete and...utilization management principles. + Experience in case management, utilization review , or related healthcare roles. +… more
- SSM Health (WI)
- …a calling** WI-REMOTE **Worker Type:** Regular **Job Highlights:** + **Department:** Utilization Review + **Schedule:** Full Time, Day Shift, 8:30am-5:00pm; ... four states (IL, MO, WI, and OK)._ **Candidate** **must** **have prior hospital utilization review experience** **and** **2 years inpatient RN experience (ER and… more
- Sharp HealthCare (San Diego, CA)
- …UR Manager, Physician Advisor, as appropriate.Participate in system or site-level utilization review activities and projects as needed.Maintain a log and ... and internal transfer requests and direct admission requests. This position supports utilization review functions to ensure appropriate patient status and… more
- The Cigna Group (Franklin, TN)
- The Chief Medical Officer (CMO) Utilization Management will develop and manage efforts to improve and maintain cost and utilization trends. Responsible for ... CMS, departments of insurance, or other outside regulators + Evaluate utilization trends, referral patterns, fraudulent medical practices, quality standards,… more
- UNC Health Care (Hillsborough, NC)
- **Description** RN Utilization Manager is responsible for clinical reviews for medical necessity for both admission and continuing stay patients during the day ... Manager is responsible for revenue protection by reconciling physician orders, bed billing type, and medical ...as necessary to resolve barriers through appropriate administrative and medical channels. 4. Utilization Outcomes Management -… more
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