- Sanford Health (SD)
- …- 28.00 **Department Details** opportunity to work remote **Job Summary** Monitors the utilization of resources, risk management and quality of care for patients ... Collection of clinical information necessary to initiate commercial payor authorization . Obtain and maintain appropriate documentation concerning services in… more
- Baptist Memorial (Memphis, TN)
- Summary The Authorization Coordinator is responsible for facilitating information documentation and transmission vital to the effectiveness of utilization ... services using evidence based criteria. Areas of work include payer notification, authorization management , denial management , escalations, and communication… more
- Fallon Health (Worcester, MA)
- **Overview** **The Authorization Coordinator works M - F 8 am to 5 pm/ 8:30 am to 5 pm and will require at least 6 months of training 5 days/week in the office ... NCQA standards, other applicable regulatory requirements, and customer expectations. The FH Authorization Coordinator serves to administer the FH prior … more
- Desert Parkway Behavioral Healthcare Hospital (Las Vegas, NV)
- …authorizations are initiated with appropriate payor, required notes are documented, and the authorization detail is set up in Case Management . The information is ... all days are authorized and identify denied days, coordinate with Director of Utilization Review and add to Denial Tracker when appropriate. Monitor and update file… more
- VNS Health (Manhattan, NY)
- …+ Advanced personal computer skills, including Word, Excel or Access required + Utilization Management experience preferred CAREERS AT VNS Health The future of ... authorization requests and/or activities + Communicates with Care Management , Member Services, Membership and Eligibility and other internal departments… more
- Prime Healthcare (Boonton Township, NJ)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/185117/ utilization -review- coordinator -%28pd%29/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... for contacting external case managers and managed care organizations for pre- authorization , concurrent reviews and appeals/denials management throughout the… more
- Sutter Health (Santa Rosa, CA)
- …as appropriate to Managed Care physicians and/or nurses as per the Utilization Management (UM) protocols. Maintains required turnaround times for referral ... completion. Assists providers and patients with referral status questions. Participates in development and implementation of improvements to the referral process and workflows. **Onsite Position** **Job Description** : **EDUCATION:** HS Diploma or GED **SKILLS… more
- State of Massachusetts (Taunton, MA)
- …Health (DMH) is seeking a dynamic candidate to be the Southeast CYF Case Management Supervisor, Human Services Coordinator II (HSC II), assigned to the Taunton ... of Mental Health* **Title:** *Child, Youth and Family Services Case Management Supervisor - Human Services Coordinator II* **Location:**… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Case Management (CM) Coordinator position is a proficient CM representative that provides technical, clerical and data management ... etc. **FINANCE ESSENTIAL FUNCTIONS** + Proactively secures reimbursement/certification and authorization -related needs, independently and escalates to management … more
- Martin's Point Health Care (Portland, ME)
- …"Great Place to Work" since 2015. Position Summary Position Summary: The Health Management Referral Coordinator is responsible for coordination and processing of ... out-of-network referral, authorization , and appeal requests to determine whether the out-of-network...be provided within the Martin's Point network. The Referral Coordinator serves as liaison between members and the plan… more
- Lawrence General Hospital (Lawrence, MA)
- …advisor and healthcare team supports all administrative tasks/responsibilities for utilization management and revenue integrity cycle processes. Interacts ... goal of maintaining high-quality cost-effective care. The URS works collaboratively with utilization management staff to obtain information from clinical reviews… more
- Community Health Systems (Franklin, TN)
- …clinics, imaging centers, cancer centers and ambulatory surgery centers. **Summary:** Utilization management is the analysis of the necessity, appropriateness, ... of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both...services are not only appropriate, but ensures that an authorization for services is obtained from payer, if required,… more
- Baptist Memorial (Jackson, MS)
- …include status management , medical necessity reviews, verification of authorization , resource utilization , and denial prevention. Responsibilities + ... Summary The Utilization Review Nurse is responsible for evaluating the...queues in the electronic medical record + Communicates with authorization coordinator + Communicates in-house high dollar… more
- Community Based Care of Brevard, Inc. (Rockledge, FL)
- …and a web based application for daily entry of case activity and the utilization management of service authorizations. 2+ years' experience serving at risk ... of services. Conduct emergency FTC's when indicated and subsequent utilization reviews for continued authorization . Ensure development of interim… more
- Oregon State University (Gold Beach, OR)
- …Associate Program Leader, and the Coastal Regional Director. This 4-H/ FCH Program Coordinator is responsible for the management , promotion, and delivery of a ... Program Coordinator works extensively with volunteers, in supervisory (program management ) and collaborative roles. The individual in this position must have… more
- Fallon Health (Worcester, MA)
- …or call center setting or physician's office; knowledge of managed care and/or utilization management strategies advisable + High level competency with "customer ... or call center setting or physician's office; knowledge of managed care and/or utilization management strategies advisable + High level competency with "customer… more
- ChenMed (Portsmouth, VA)
- …market leaders, external clients and HMO to establish, maintain and support outpatient utilization management in PMR and delegated utilization management ... necessary. **_Other responsibilities may include:_** + Drive the current delegated/non-delegated utilization management model to a sustainable and reproducible… more
- Baylor Scott & White Health (Temple, TX)
- … authorization requests for medical services by entering them into the utilization management system. Communicates prior authorization status information ... **JOB SUMMARY** The Intake Coordinator 1 serves as help to the health plan?s Utilization Management teams. The incumbent is accountable for incoming phone… more
- Centers Plan for Healthy Living (Margate, FL)
- …with the guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team ... UM Coordinator 5297 W Copans Rd, Margate, FL 33063,...in our Managed Long Term Care program and facilitate authorization requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists… more
- CVS Health (Austin, TX)
- …and affordable. Candidates **MUST HAVE AT LEAST TWO YEARS OF** prior authorization experience. Schedule: For training there is a set schedule 8am-430pm CST ... reviews as per the health plan/employer agreed criteria, including inbound from the coordinator as needed as well as outreach calls to physician offices. -Conducts… more
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