- 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 ... population and Hackensack UMC. These include but are not limited to utilization review ,** **hospital reimbursement, clinical compliance, case management, and… 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
- Henry Ford Health System (Detroit, MI)
- …Previous experience as Director of Utilization Review or Physician Advisor preferred. CERTIFICATIONS/LICENSURES REQUIRED: + Michigan Medical license + ... The Medical Director of Utilization Review...The Medical Director of Utilization Review is responsible for the...a timely manner 9. Code 44s - UM committee physician concurrent statement. CMS Conditions of Participation 10. Lead… 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
- Munson Healthcare (Traverse City, MI)
- …interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic work ... State of Michigan. + Minimum of three years clinical experience required. Previous utilization review and/or case management in a hospital or insurance industry… more
- Sutter Health (Berkeley, CA)
- …staff and other departments regarding documentation required for utilization review activities and processes. Collaborate with medical , nursing and other ... hospital administration, medical staff, patient registration and representatives of review organizations and others to ensure effective utilization of… 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
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: This Utilization Review Denials Review ...DRU 3 Team Lead writes appeal letters using UR medical directors and the medical team for ... (DRU) 3 Team Lead will assist the Director of Utilization Review and the Associate Director of...possess comprehensive and broad knowledge of complex clinical and medical concepts and demonstrate overall proficiency in clinical conceptual… more
- 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
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review , under the supervision and in collaboration with the ... Manages the activities of hospital staff in inpatient care coordination and utilization review . Oversees interactions of staff with outside activities and… more
- Trinity Health (Springfield, MA)
- …Type:** Part time **Shift:** Rotating Shift **Description:** Requires BSN At **Mercy Medical Center** the ** Utilization Review /Appeals & Denials** **RN** ... utilization review with payers, assists the physician with level of care determinations using screening criteria,...Option A, 4 Shifts a month** **Ministry/Facility Information** **Mercy Medical Center** has established itself as one of the… 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
- R1 RCM (Pittsburgh, PA)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. **Title: Utilization Review Author** **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 Author** , you will help… more
- Baptist Memorial (Jackson, MS)
- 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
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Utilization Review Clinical Review (CR) 3 Team Lead will assist the Director of UR and Associate Director of UR with daily staff mentoring, ... of service for admission and continued stay at the time of medical record screening. Responds to Managed Care/Insurance Company inquiries regarding admission,… more
- Providence (Mission Hills, CA)
- …concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records daily during admission for all payers, as required ... strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The… 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
- 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
- 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
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