- CommonSpirit Health (Englewood, CO)
- …happen both inside our hospitals and out in the community. **Responsibilities** The Utilization Management Physician Advisor II (PA) conducts clinical case ... team, medical staff, and medical executives to encourage physician cooperation and understanding of documentation importance + Assists...such as Joint Operating Committee (JOC), as requested by Utilization Management or Care Management .… more
- CommonSpirit Health (Phoenix, AZ)
- …both inside our hospitals and out in the community. **Responsibilities** As the Utilization Management Physician Advisor (PA), the PA conducts clinical ... care services. The PA communicates remotely with case and utilization management to discuss selected cases and...+ Minimum of 1 year of experience as a Physician Advisor preferred. + Minimum of 5 years of… more
- Tenet Healthcare (Detroit, MI)
- …initiatives. Utilizes Crimson data to provide timely and meaningful information to the Utilization Management Committee and physician staff for performance ... for case management scope of services including: Utilization Management supporting medical necessity and denial...processes to prevent payer disputes, f) develops and provides physician education and feedback on hospital utilization ,… more
- Covenant Health Inc. (Knoxville, TN)
- …communication links with Integrity Office, Coding/Transcription, Quality Management , Case Management , Utilization Management , Physician Advisors and ... feedback on program objectives. + Works closely with KBOS, RAC Physician Advisors, Utilization Management , Quality Management and Coding personnel… more
- Munson Healthcare (Traverse City, MI)
- …hospital associates at information meetings. + May represent Utilization Management on various committees, professional organizations, physician or and ... of resources. + Assists in developing and revising policies to support utilization management activities, including criteria and guidelines for appropriate use… more
- Catholic Health Services (Melville, NY)
- …clinical documentation. | Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as required. | Communicates ... changes from the Managed Care Department and applies to UM and appeals management processes. | Works collaboratively with physicians, physician office staff and… more
- Community Health and Counseling Services (Bangor, ME)
- …authorizations, collaborating with Agency staff, patients, family members, facilities and physician . Responsible for utilization management of services, ... Insurance Verification and Utilization Review Specialist - Health Services Job Type(s):Full-Time...Coordination of payor changes as well as claims denial management . Medical Terminology and computer coursework or equivalent required.… more
- Hackensack Meridian Health (Hackensack, NJ)
- …- OBS vs. Inpatient** **c. Liaison to the Medical Staff supporting Utilization Management Committee processes** **d. Hospital Based Appeals Management ... **Overview** **The Utilization Review Physician collaborates with the... and Organizational Strategy** **a. Development & implementation of Utilization Management strategies to assure appropriate** **health**… more
- Hackensack Meridian Health (Hackensack, NJ)
- …a. Provides direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight for accurate patient ... determinations - OBS vs. Inpatient c. Liaison to the Medical Staff supporting Utilization Management Committee processes d. Hospital Based Appeals Management … more
- Catholic Health Services (Melville, NY)
- … Advisors during the monthly Physician Advisor meeting. Attends hospital Utilization Management (UM) committees. Supervises the Facility Physician ... develops standard system-wide implementation plans and policies. Works with system Care Management (CM) leadership and Catholic Health Physician Advisors (as… more
- University of Miami (Miami, FL)
- …Utilizes data to analyze and monitor level of care and length of stay management , physician utilization relative to national and individual hospital ... Care Coordination provides strategic leadership and oversight of care coordination, case management , social services, and utilization management across all… more
- Sharp HealthCare (San Diego, CA)
- …the episode of care and supports other members of the System Centralized Utilization Management team to ensure final status reconciliation. This position ensures ... Degree in a health related field. + 3 Years Utilization Management or case management ...Physician Advisor, as appropriate.Participate in system or site-level utilization review activities and projects as needed.Maintain a log… 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 ... with Trinity Health experts in managing and developing medical utilization programs and documentation initiatives. **Work Experience** **Job Description:** Saint… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- Hackensack Meridian Health (Holmdel, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management ** is a member of the healthcare team and is ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- Sharp HealthCare (San Diego, CA)
- …Qualifications** + Bachelor's Degree in Healthcare or a related field + 3 Years Utilization Management or case management within a hospital or payer ... Guidelines (MCG) + Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager (ACM) - American Case… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …medical necessity criteria and BCBSMA policies and procedures + Focus on efficient utilization management with emphasis on discharge planning + Understand and ... to obtain and/or share information relating to benefits and the BCBSMA utilization management process + Collaborate with members/families, providers, medical… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours week. + **Hospital:** Ascension Saint Thomas + **Location:** ... TN market. We're looking for an experienced Director of Utilization Management to join our team! In...to enhance our processes. You'll collaborate with Market Care Management , Finance, CDI, and Physician Advisors to… more
- Fairview Health Services (St. Paul, MN)
- **Overview** **Fairview Health Services is hiring a casual** ** Utilization Management Spec RN** **to join our Revenue Cycle Management team. This is a remote ... **Job Expectations:** + Perform and document timely and accurate utilization management review to ensure compliance with...length of stay and discharge planning. + Facilitate secondary physician review with the physician advisor and/or… 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 ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
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