- Chestnut Health Systems (Carlock, IL)
- …aging report; follow up on unpaid claim balances. Communicate with Utilization Review Coordinator regarding authorizations and appeals, documenting all communication ... in EHR. Respond to communication from assigned payers. Maintain an organized filing system. Function as a team member, supporting other team members as necessary. Qualifications Position requires a high school diploma or GED plus at least one year of… more
- Commonwealth Care Alliance (Boston, MA)
- CCA-Auth & Utilization Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and ... quality team.collaboration with the broader clinical organization. * Ensures that utilization management processes are integrated with care management and care… more
- State of Michigan (Lansing, MI)
- Medicaid Utilization Analyst 9-12 - BPHASA MEDICAL EQUIPMENT & SERVICES SECTION Print (https://www.governmentjobs.com/careers/michigan/jobs/newprint/4741189) Apply ... Medicaid Utilization Analyst 9-12 - BPHASA MEDICAL EQUIPMENT & SERVICES...visit our MDHHS Diversity, Equity, and Inclusion Plan. Medicaid Utilization Analyst 12 This position functions as a clinical… more
- Beth Israel Lahey Health (Burlington, MA)
- …Center is now offering up to a $3,500 in signing bonuses for our Utilization Review positions. Important Details: * Signing Bonuses are paid out in three payments. ... time. **Job Description:** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status… more
- Centene Corporation (Madison, WI)
- …Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and facilitates ... operations within utilization management. + Manages prior authorization, concurrent review, and...applicable guidelines, policies, and procedures + Reviews and analyzes utilization management activities, operations, costs, and forecasted data to… more
- New York State Civil Service (New York, NY)
- NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), NYC Children's Center, Queens Campus, P25875 Occupational Category ... 11426 Minimum Qualifications NYC Children's Center is recruiting for a Utilization Review Coordinator to analyze and evaluate quality, effectiveness, and efficiency… more
- UNC Health Care (Chapel Hill, NC)
- **Description** Surgery, Women's, & Children's Utilization Manager **(part-time: 20 hrs/week)** + Weekends only (Saturday & Sunday) + 8:30a-6:30p + **No Nights** + ... episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to… 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
- Covenant Health Inc. (Louisville, TN)
- Overview Utilization Review Coordinator, Quality Management Full Time, 80 Hours Per Pay Period, Day Shift Peninsula Overview: Peninsula, a division of Parkwest ... Hospital to identify and address problems related to the utilization process and to monitor and track the resolution...Health. + Assists in the formulation of health service utilization and cost forecasts with ongoing responsibility to monitor… 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 integrity of ... and Hackensack UMC. These include but are not limited to utilization review,** **hospital reimbursement, clinical compliance, case management, and transitions of… more
- ERP International (Nellis AFB, NV)
- **Overview** ERP International is seeking **Registered Nurse (RN) Utilization Managers** for full-time positions in support of theMike O'Callaghan Military Medical ... No Weekends, No Holidays! **Job Specific Position Duties:** * Provides Utilization Management activities and functions by using MTF specific Quality Improvement… more
- Trinity Health (Boise, ID)
- …years' experience in hospital based medicine with exposure to utilization management and documentation initiatives. 3. Demonstrated teamwork, performance analysis, ... with Trinity Health experts in managing and developing medical utilization programs and documentation initiatives. **Work Experience** **Job Description:** Saint… more
- VNS Health (Manhattan, NY)
- OverviewManages the utilization management team to ensure that standards for service delivery and team/staff performance levels are met or exceeded. This includes ... the VNS Health Plans teams on a day- to-day basis for utilization issues, problem resolution, complaint resolution and other service related issues. Manages… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR ... direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the… more
- Sharp HealthCare (San Diego, CA)
- …the System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized Patient Placement Center (CPPC) ... internal transfer requests and direct admission requests. This position supports utilization review functions to ensure appropriate patient status and assists with… more
- Stanford Health Care (Palo Alto, CA)
- …**This is a remote 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. Coordination with… more
- CVS Health (Columbus, OH)
- …affordable. **Primary Job Duties & Responsibilities** + Drives effective utilization management practices by ensuring appropriate and cost-effective allocation of ... facilitating appropriate healthcare services/benefits for members. + Conducts routine utilization reviews and assessments, applying evidence-based criteria and clinical… more
- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in Bethesda, Maryland to ... on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW: + Initiate, perform and complete assigned duties in providing care… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 241106-5613FP-001 Location East Hartford, CT Date Opened 11/7/2024 12:00:00 AM Salary ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=) position, located… more
- Sharp HealthCare (San Diego, CA)
- …Management (ICM) team the Per Diem RN (Adv CN)-Unit A4 position supports utilization review functions to ensure appropriate patient status before the patient is ... ensuring compliance with all local, state and federal regulations governing utilization review activities and/or care management. Expected outcomes include meeting… more
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