- Sutter Health (Davis, CA)
- …the acute care patient experience. This position works in collaboration with the Physician , Utilization Manager , Medical Social Worker and bedside RN ... the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self -determination while coordinating… more
- Community Health Systems (Franklin, TN)
- …additional documentation from the physician (s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if physicians are ... hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine… more
- Community Health Systems (Franklin, TN)
- …additional documentation from the physician (s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if physicians are ... hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine… more
- 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 ... and Hackensack UMC. These include but are not limited to utilization review,** **hospital reimbursement, clinical compliance, case management, and transitions of… 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 integrity ... and Hackensack UMC. These include but are not limited to utilization review, hospital reimbursement, clinical compliance, case management, and transitions of… more
- Sharp HealthCare (San Diego, CA)
- …Will Do** As a member of the System Integrated Care Management (ICM) team the Utilization Manager (UM) II position supports utilization review functions to ... Guidelines (MCG) + Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager (ACM) - American Case… more
- UNC Health Care (Chapel Hill, NC)
- …care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management ... needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in… more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... from payors for additional clinical documentation. | Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as… 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
- UNC Health Care (Hendersonville, NC)
- …the health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge review ... met and care delivery is coordinated. The UM completes utilization reviews in accordance with federal regulations and the...patient data and treatments. Communicates daily with the Care Manager to manage level of care transitions & appropriate… more
- Sharp HealthCare (San Diego, CA)
- …of the System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized Patient Placement Center ... (MCG). + Experience and understanding of federal and state regulations governing utilization management. + Accredited Case Manager (ACM) - American Case… more
- Munson Healthcare (Traverse City, MI)
- …the patient's clinical status and progression of care. + Consults with case manager and/or physician advisor as necessary to resolve progression-of-care barriers ... colleagues and hospital associates at information meetings. + May represent Utilization Management on various committees, professional organizations, physician … more
- Hackensack Meridian Health (Neptune, NJ)
- …and serve as a leader of positive change. The **Care Management, Care Coordinator, Utilization Management** is a member of the healthcare team and is responsible for ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of stay,… more
- Hackensack Meridian Health (Holmdel, NJ)
- …healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management** is a member of the healthcare team and is responsible for ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of stay,… more
- Fairview Health Services (St. Paul, MN)
- …on a variety of special projects and assume other duties as assigned by the Utilization Review Manager or Supervisor. + Understand and focus on key performance ... **Overview** **Fairview Health Services is hiring a casual** ** Utilization Management Spec RN** **to join our Revenue...length of stay and discharge planning. + Facilitate secondary physician review with the physician advisor and/or… more
- LA Care Health Plan (Los Angeles, CA)
- …to develop and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service ... Utilization Management Nurse Specialist RN II Job Category:...cases and reports are maintained and referred to the Physician Advisor/UM Director. Document in platform/system of record. Utilize… more
- Scottish Rite for Children (Dallas, TX)
- …Implement and monitor processes to prevent payer disputes, + Develop and provide physician education and feedback on hospital utilization , + Ensure compliance ... back their childhood! Job Posting Title: Director of Case Management and Utilization Management Location: Dallas - Hospital Additional Posting Details: Monday -… more
- Dignity Health (San Bernardino, CA)
- …https://www.dignityhealth.org/socal/locations/san-bernardino for more information. **Responsibilities** The Utilization Review Specialist is responsible for ... hospitalization. This role collaborates with attending physicians, consultants, second-level physician reviewers, and Care Coordination staff, using evidence-based guidelines… more
- BronxCare Health System (Bronx, NY)
- …as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate with ECFMG certification preferred . ... Prior experience with reviewing medical charts in a medical office or hospital would be preferred. Knowledge of Interqual / MCG guidelines will be a benefit. - Knowledgeable regarding CMS, JCAHO, IPRO standards, regulations, monitoring and reporting systems. -… more
- Glens Falls Hospital (Glens Falls, NY)
- *The Impact You Can Make * Works in collaboration with the physician and interdisciplinary team to support the underlying objective of enhancing the quality of ... timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and removing… more