- Alameda Health System (Oakland, CA)
- …each individual in the classification. Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. ... utilization reviews and determine program improvements. Develop and implement utilization review policies and procedures in accordance with industry… more
- Alameda Health System (Oakland, CA)
- …for patients, improve the quality of patient care and maximize the efficient utilization of physician and hospital resources. Report to departmental leadership ... Emergency Medicine Physician + Oakland, CA + Highland General Hospital...for Alameda Health System, under employment from Alameda Health Medical Group. Services will be on-site at Highland Hospital.… more
- Stanford Health Care (Palo Alto, CA)
- …various problem-solving techniques to deal with technical queries. + Demonstrated ability to review utilization reports and data. + Ability to identify trends ... plan, providers, caregivers, family, and the patient. + Identify opportunities to improve utilization , quality of care, access issues and physician profiling. +… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …appropriate procedure and diagnosis codes, and support business decisions regarding utilization management activities and guidelines. + Support medical policy ... by identifying and updating appropriate procedure and diagnosis codes for company medical policies and UM ( Utilization Management) guidelines that reflect … more
- Stanford Health Care (Palo Alto, CA)
- …provides clinical direction and education, works closely with operational and physician leaders, and has oversight of hiring, termination, and professional growth ... Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), or the Physician Assistant (PA) Job Description approved by the Interdisciplinary Practice… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …results-driven **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical directors/ physician reviewers, network physicians, ... to enhance understanding of criteria application, benefit use, and the appeal, External Medical Review (EMR), and Fair Hearing processes + Coordinate: Ensures… more
- Stanford Health Care (Palo Alto, CA)
- …Provides clinical direction and education, works closely with operational and physician leaders, and has oversight of hiring, termination, and professional growth ... Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), or the Physician Assistant (PA) Job Description approved by the Interdisciplinary Practice… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more
- Stanford Health Care (Palo Alto, CA)
- …planning, hiring and termination, and working closely with operational and physician leaders on a wide variety of organizational initiatives. **Locations** Stanford ... Care **What you will do** + Partners with the Medical Director and unit nursing management team, participates in...and adherence to policy through practice analysis and case review of APPs with physicians. + Investigates and responds… more
- Stanford Health Care (Palo Alto, CA)
- …and Academic Medical Center experience preferred. + Case management, utilization review and/or direct provider interaction experience, preferred. + ... Line Outcomes Lead is responsible for partnering with service line & physician leadership to optimize documentation tools, improve processes, and develop strategies… more
- Stanford Health Care (Palo Alto, CA)
- …+ Uses independent judgement to assess, identify, and prioritize clinical information to physician , NP, PA and other clinicians for patients who are being evaluated ... care as defined by the research protocol with the physician and other health care professionals and research team...documenting the education regarding the clinical trial in the medical record. + Alerts principal investigator of any concerns… more
- Katmai (Usaf Academy, CO)
- …procedures, treatments and medications are administered in accordance with (IAW) physician orders, sound nursing judgment and applicable guidelines. + Accurately ... and physical protection of patient information. + Generate and maintain proper medical records on beneficiaries to whom treatment is provided in accordance with… more
- Battelle Memorial Institute (Arlington, VA)
- …current notes in the electronic medical records of all patients contacted for review by the managing physician + Routinely staff difficult cases with the ... conducting applied research, consulting with multidisciplinary teams, maintaining detailed medical records, possibly supervising trainees, performing case management, and… more
- Stanford Health Care (Menlo Park, CA)
- …which includes strategic planning, financial performance management, resource utilization , contract administration, operational metrics, lease administration, and ... the dynamics of these individuals. + Work with and drive change across physician groups that balance clinical, academic and research interests. + Project Management… more
- Stanford Health Care (Palo Alto, CA)
- …budgets, and provide progress status reports to key stakeholders, which may include physician leaders and executive leadership. + Review and assess performance ... practice based on evidence by using research based knowledge or research utilization methods to identify and implement innovations in patient care and/or… more
- Hackensack Meridian Health (Hackensack, NJ)
- The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical ... records for the patient population and Hackensack University Medical Center. These include but are not limited to... Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case… more
- Hackensack Meridian Health (Hackensack, NJ)
- **The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- The County of Los Angeles (Los Angeles, CA)
- …recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the committee of new or ... Medi-Cal reimbursement. + Analyzes cases for referral to the physician advisor to ensure that the admission or continued...I:One year of experience performing the duties of a Utilization Review Nurse* or Medical … more
- Integra Partners (Troy, MI)
- …as operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director(s), ensures consistent application of ... representing Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director's responsibilities include but… more
- The County of Los Angeles (Los Angeles, CA)
- …administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the ... Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician...for and the effective conduct of the system to review patients' medical charts to ascertain the… more
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