- Humana (St. Paul, MN)
- …our caring community and help us put health first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM ... member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the...appeals. JOB RESPONSIBILITIES + Monitor incoming faxes + Enter UM authorizations review requests in UM ... HCPC codes + Maintaining expected timelines EXPERIENCE: + 1 year as a UM Coordinator in a managed care payer environment preferred + Knowledge of ICD-10, HCPCS… more
- Saint Francis Health System (Tulsa, OK)
- …participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of ... administrative and clinical support to the hospital and treatment team throughout the review of patients, their placement in various levels of care and their receipt… more
- Sharp HealthCare (San Diego, CA)
- …roundsReviews every patient under assigned workload initially and reviews based on review of care plan.Makes rounds and sees every patient identified per ... departmental guidelines during hospital stay beginning with the admission review of the case manager and reviews with the Case Manager Lead, as needed.Keeps SRS… more
- Tenet Healthcare (Detroit, MI)
- …of care and appropriate level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as needed. (5% daily, ... RN Utilization Review - Case Management -...an authorization process Closes open cases on the incomplete UM Census Completes the Medicare Certification Checklist on applicable… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management ( UM ) program for all TRICARE eligible beneficiaries within the ... and the TRICARE Operations Manual (TOM) access to care standards for appropriate utilization of services. Perform utilization management/ review for medical… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... a sign-on bonus of 10% of salary for this position. The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for… more
- Dignity Health (Los Angeles, CA)
- …90 days of hire. + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... bonus not to exceed 10% of salary for this position. The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients… more
- Dignity Health (Glendale, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients… more
- Cedars-Sinai (Beverly Hills, CA)
- …for medical necessity, appropriateness of care and level of care. Use evidence based review guidelines to conduct utilization review as is appropriate to ... innovation. **A Little More About What You Will be Doing** The RN Care Coordinator is responsible for the case management of patient while hospitalized and upon… more
- Corewell Health (Dearborn, MI)
- …patients. + Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). + ... years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + Registered… more
- Corewell Health (Royal Oak, MI)
- …patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. ... years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + Registered… more
- University of Michigan (Ann Arbor, MI)
- …to inventory and order missing or replacement instruments. + Conduct daily walk-throughs, review low-on shelf reports, and analyze instrument utilization data. + ... CSPD Instrument Coordinator / Liaison Apply Now **Job Summary** The...Instrument Ordering App and Finance BI reporting. + Provide utilization and trend data to support purchasing decisions, denials… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors ... status of approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of… more
- University of Southern California (Alhambra, CA)
- …+ Req 5 years Clinical experience + Req 2 years Ambulatory case management or utilization review experience within the last three years + Req Ability to work ... The role integrates the functions of complex case management, utilization management, quality management, discharge planning assessment, and coordination of… more
- Highmark Health (Pittsburgh, PA)
- …RESPONSIBILITIES** + Prior Authorization & Utilization Management: Reviews pharmacy utilization management ( UM ) coverage requests for both pharmacy and ... medical benefits and prepares such cases for clinical review when required. Within the context of the request,...years of experience as a Pharmacy Technician, Patient Access Coordinator , or Medical Assistant in health care setting **Preferred**… more
Related Job Searches:
Coordinator,
Review,
UM Coordinator,
Utilization,
Utilization Review,
Utilization Review Coordinator