• Physician Advisor Denials Management

    CommonSpirit Health (Sacramento, CA)
    …out in the community. **Responsibilities** **This is a remote position.** **Summary** The Utilization Management Physician Advisor II conducts clinical case ... committee meetings such as Joint Operating Committee (JOC), as required for Utilization Management . + Contacts Attending Physicians: Makes face-to-face and… more
    CommonSpirit Health (09/20/24)
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  • Manager Utilization Management - Day…

    Penn State Health (Hershey, PA)
    …performing the processes. The incumbent is responsible for identifying and communicating utilization management concerns to physician and administrative ... **SUMMARY OF POSITION:** Position is responsible to thoroughly understand all Utilization Management regulatory requirements for both CMS and DOH,… more
    Penn State Health (11/16/24)
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  • Mgr CDI

    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
    Covenant Health Inc. (09/14/24)
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  • Utilization Review Specialist - PRN

    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
    Munson Healthcare (11/09/24)
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  • Utilization Review Physician Full…

    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 (11/02/24)
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  • Physician Advisor - Director (Facility)

    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
    Catholic Health Services (11/14/24)
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  • Physician Utilization Review…

    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
    Hackensack Meridian Health (11/18/24)
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  • Physician Reviewer- Sharp Health Plan | CA…

    Sharp HealthCare (San Diego, CA)
    …+ Physician Responsibilities + Performs Medical Necessity Reviews including utilization management and appeals and grievances. Assists physician ... **What You Will Do** The position is responsible for the performing medical utilization reviews and appeals and grievance reviews under the direction of the Senior… more
    Sharp HealthCare (10/26/24)
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  • Utilization Mgmt ED RN - Case…

    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.… more
    Stanford Health Care (09/21/24)
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  • UMII Transfer and Admission - Utilization

    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
    Sharp HealthCare (09/06/24)
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  • Per Diem RN - Utilization Management

    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
    Sharp HealthCare (11/02/24)
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  • RN Utilization Manager - Rex Case…

    UNC Health Care (Raleigh, NC)
    …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... case management referrals. Initiates appropriate social work referrals. 3. Utilization Management Process - Performs utilization management more
    UNC Health Care (11/07/24)
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  • Medical Director: Documentation…

    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
    Trinity Health (10/14/24)
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  • Care Coordinator, Utilization

    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 (11/15/24)
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  • Care Coordinator, Utilization

    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
    Hackensack Meridian Health (11/14/24)
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  • SRS-Inpatient Case Manager II - Utilization

    Sharp HealthCare (San Diego, CA)
    …competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as ... as Allscripts.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation… more
    Sharp HealthCare (10/30/24)
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  • Market Director of Utilization

    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
    Ascension Health (10/25/24)
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  • Utilization Management Nurse…

    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
    LA Care Health Plan (11/09/24)
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  • Interim Manager - Case Management

    Trinity Health (Silver Spring, MD)
    …closely related area. + Extensive knowledge of payer mechanisms and clinical utilization management is required. + Knowledge of pertinent regulatory, ... **Employment Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review, under the supervision and in… more
    Trinity Health (10/10/24)
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  • Utilization Management Reviewer…

    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
    Blue Cross Blue Shield of Massachusetts (10/25/24)
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