- 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
- Munson Healthcare (Traverse City, MI)
- …families, interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic ... State of Michigan. + Minimum of three years clinical experience required. Previous utilization review and/or case management in a hospital or insurance industry… 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 ... of medical services and procedures in the hospital setting. Utilization review is the assessment for medical...have an ED Case Manager present, the UR Clinical Specialist will collaborate with Emergency Room Physician /staff… 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 ... medical services and procedures in a Behavioral Health setting. Utilization review is the assessment for medical...the case management system by the UR Behavioral Health Review Specialist . + UR Clinical Specialist… more
- Lawrence General Hospital (Lawrence, MA)
- The Utilization Review Specialist , under...with the Utilization Review Coordinator, Utilization Review Nurses, Physician advisor ... well as the integrated care team and supports the case management/ utilization review team on system-wide quality improvement/performance improvement initiatives.… more
- CaroMont Health (Gastonia, NC)
- …RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal ... practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case Management preferred. Minimum… more
- Sutter Health (Berkeley, CA)
- …and others to ensure appropriate utilization and quality care through utilization review , tracking and evaluation and objectively compare criteria with ... clinical nursing staff and other departments regarding documentation required for utilization review activities and processes. Collaborate with medical, nursing… more
- Bakersfield Behavioral Healthcare Hospital (Bakersfield, CA)
- …leadership, teamwork, and communication skills. ESSENTIAL DUTIES The primary responsibility of the Utilization Review Specialist is to review medical ... of candidates. Education Associates Degree preferred Minimum Work Experience Utilization Review experience preferably in a behavioral/psychiatric healthcare… more
- HonorHealth (Scottsdale, AZ)
- …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Mount Sinai Health System (New York, NY)
- …Operating Room Surgical Scheduling, Mount Sinai West - Full Time, Days** The Utilization Review Specialist coordinates scheduling of all surgical/endoscopic ... **Job Description** ** Utilization Review Admission Specialist ...and operating roaom time. 7. Checks credentials system for physician 's delineation of privileges for equipment and/or procedures according… more
- Medical Center Hospital (Odessa, TX)
- Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician Advisors. Education: Holds a current Texas license as a… more
- Community Health and Counseling Services (Bangor, ME)
- Insurance Verification and Utilization Review Specialist - Health Services Job Type(s):Full-Time Location(s):Bangor, Maine Education:Associates Degree - ... collaborating with Agency staff, patients, family members, facilities and physician . Responsible for utilization management of services, verifying… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Dignity Health (San Bernardino, CA)
- …systems. Visit https://www.dignityhealth.org/socal/locations/san-bernardino for more information. **Responsibilities** The Utilization Review Specialist is ... + AHA BLS + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Proficient in application of clinical guidelines… more
- Sanford Health (SD)
- …also acceptable, ie Certified Coding Specialist (CCS), Certified Coding Specialist - Physician based (CCS-P), Certified Professional Coder (CPC), Certified ... Details** opportunity to work remote **Job Summary** Monitors the utilization of resources, risk management and quality of care...is not exceeded without due notice to the attending physician . May also need to notify physician … more
- St. Luke's University Health Network (Allentown, PA)
- …registrations and/or physician queries + Serves as liaison between Physician Advisor/Medical Director, Finance, Utilization Review Department and ... patient's ability to pay for health care. The Surgical Review Specialist prospectively reviews, validates, and audits...lost with feedback to respective departments + Conduct concurrent review with utilization review department… more
- HCA Healthcare (Kansas City, MO)
- …goals. Unlock your potential! **JOB SUMMARY:** The Consulting Provider Solutions Specialist serves as a subject-matter expert for physician -facing technologies. ... growth, we encourage you to apply for our Consulting Provider Solutions Specialist opening. We promptly review all applications. Highly qualified candidates… more
- Alameda Health System (San Leandro, CA)
- … utilization and an appropriate level of care. 5. Coordinates all utilization review functions, including response to payor requests for concurrent and ... Care Management Clinical Appeals Specialist + San Leandro, CA + Finance +...of Case Management experience in an acute setting or utilization review at a medical group or… more
- Mohawk Valley Health System (Utica, NY)
- … regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of...and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides… more
- Health First (Cocoa Beach, FL)
- …'s direction. * Records temporary playback of procedure for initial, immediate review by physician . * Insure supplies, implants, and consignment items ... a timely, safe and efficient manner. The Cardio Invasive Specialist is expected to work in a team environment...hemodynamic and angiographic techniques as observed by the attending physician . Assists the physician and anticipates equipment… more
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