- Humana (Columbus, OH)
- …effectively with various stakeholders to drive strategic advancements in the Clinical - Utilization Management operating model. The Advisor must exercise ... and help us put health first** The Strategy Advancement Advisor plays a crucial leadership role that provides data-driven...**Manage the operating model elements of the Clinical - Utilization Management (UM) domain** + Serve as… more
- Veterans Affairs, Veterans Health Administration (Reno, NV)
- …performance improvement, risk management and peer review activities. Reviews all VHA Utilization Management Advisor ) for Utilization Management , ... the Medical Center ELT. Works with Fiscal Service, Business Office, Human Resources Management Service, and as a full member of the Executive Leadership Team.… more
- Beth Israel Lahey Health (Burlington, MA)
- …to challenge physician practices to achieve the organization's desired resource management and quality goals. **Job Description:** Purpose: Provide leadership ... directly to the Chief Medical Officer (CMO), the Physician Advisor will play an active role in optimizing healthcare...efficient resource allocation - Serves as physician expert and provide support to utilization review team regarding… more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …promote quality improvement for the facility; this includes participation as a physician utilization management advisor . Participate in VISN 6 Hospital ... maintain updates on VA Functional Statements and Position Descriptions, co- management of pay panel preparation. Responsible for orienting new hospitalist… more
- Sedgwick (Memphis, TN)
- …to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Physical Therapy Utilization Review Advisor **PRIMARY PURPOSE** **:** Counsels providers ... with relevant industry regulations, guidelines, and best practices related to utilization review and maintains compliance with applicable laws and regulations.… more
- The Cigna Group (Atlanta, GA)
- …market, incumbent candidate will work from local office 3 days per week.** The Provider Performance Enablement Advisor is an integral part of a cross-functional, ... Manager or Director, this individual ensures the effective performance management of the provider network for his/her... provider network for his/her assigned sub-market and/or provider groups. The role of Senior Advisor … more
- Stanford Health Care (Palo Alto, CA)
- …**This is an onsite Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN) will be responsible for ensuring ... the institution, navigating the complexities of patient care and resource utilization management , and education. Primary responsibilities include: 1.… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will… 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 ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will… more
- Trinity Health (Boise, ID)
- …of two years' experience in hospital based medicine with exposure to utilization management and documentation initiatives. 3. Demonstrated teamwork, performance ... the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is the lead provider for coordination and… more
- McLaren Health Care (Detroit, MI)
- **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm** **Shift: Days** **Scheduled Bi-Weekly Hours: 40** **Position Summary:** Responsible ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- Billings Clinic (Billings, MT)
- …Physician Advisor , per department process or procedure Insurance and Utilization Management Maintains working knowledge of CMS requirements and readmission ... recognized nationally for our exceptional quality. Your Benefits We provide a comprehensive and competitive benefits package to all...- 44.18 Under the direction of department leadership, the Utilization Review/ Management RN. This position is… more
- Dignity Health (Prescott, AZ)
- …Committee (MEC), and assist in facilitation on Facility Utilization Management Committee. **Inpatient Facility Care Coordination:** + Provide advisory ... element for CMS Conditions of Participation by active involvement in the facility utilization management processes. + Work with Chiefs of Staff / CMO's… more
- Houston Methodist (Houston, TX)
- …and CMS regulations, DNV requirements, and guidelines on case management , utilization review, and clinical documentation. + Provide ongoing education to ... discuss needs of patients and alternative levels of care. Provide consultation to case management staff regarding...actively participates in defining operational strategic objectives for the Utilization Management Program and serve as the… more
- Hartford HealthCare (Wethersfield, CT)
- …Resource Management Associate's focus is on providing support and coordination of utilization management services for the utilization management ... department. *_Position Responsibilities:_* 1. Monitors and manages assigned utilization management reports, including the Payer End of Day report, Utilization… more
- Sutter Health (San Francisco, CA)
- … will work closely with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management (CM) personnel to develop ... **Organization:** SHSO-Sutter Health System Office-Bay **Position Overview:** The Physician Advisor (PA) is a key member of the hospital's leadership team charged… more
- WellSpan Health (York, PA)
- … Management staff. Duties and Responsibilities Essential Functions: + Renders utilization management determination in accordance with State and Federal ... Physician Advisor Location: WellSpan Medical Group, York, PA Schedule:...external appeal-and funnel those cases to the Supervisor of Utilization Management for expedition. + Reviews cases… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention ... potentially avoidable days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical and financial requirements and… more
- WMCHealth (Valhalla, NY)
- …an important role in ensuring physician support and execution of for Utilization Management and Documentation strategies and processes. Responsibilities: + ... Advisor with a third party leveling and/or appeals agency preferred. Previous utilization management , case management or peer review documentation… more
- LA Care Health Plan (Los Angeles, CA)
- …health care auditing and monitoring (preferably in Appeals, Grievances, Quality Improvement, Utilization Management (UM) and so forth) and developing audit ... Care business units and participates in interdisciplinary/cross-functional teams. The Compliance Advisor may investigate, assist with coordination and management … more