- 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
- Munson Healthcare (Traverse City, MI)
- …clinical issues and advise on justification for continued stay, medical necessity and utilization management + Participates in physician education and ... Healthcare serving as a resource to the Patient Care Management (PCM)/ Utilization Management (UM)/Clinical Documentation... Utilization Review Physicians, Inc. (ABQAURP), or American Physician Leaders in Case Management ( APLCOM)… 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
- Hartford HealthCare (Wethersfield, CT)
- …Medicine * Experience: At least five years of acute care clinical experience. Physician advisor experience ( Utilization Management and Clinical Resource ... *Exciting Opportunity for Physician Advisor Clinical Resource Management * Every...as needed. *Reports To:*Associate Medical Director of Clinical Resource Management , Utilization Management and Appeals… 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
- 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
- Stanford Health Care (Palo Alto, CA)
- …role. **This is a hybrid 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
- 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 (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
- Catholic Health Initiatives (Lexington, KY)
- …both inside our hospitals and out in the community. **Responsibilities** The Utilization Management (UM) Director is responsible for the market(s) development, ... implementation, evaluation and direction of the Utilization Management Program and staff in support...agencies and internal standards and requirements 7. Collaborates with Physician Advisory Services to identify denial root causes related… more
- 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
- 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 (Neptune, 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)
- …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
- 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
- Billings Clinic (Billings, MT)
- … Physician Advisor, per department process or procedure Insurance and Utilization Management Maintains working knowledge of CMS requirements and readmission ... here. About Us Billings Clinic is a community-owned, not-for-profit, Physician -led health system based in Billings with more than...- 44.18 Under the direction of department leadership, the Utilization Review/ Management RN. This position is… 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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