- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: This Utilization Review Denials Review Unit (DRU) 3 Team Lead will assist the Director of Utilization Review and the Associate Director of ... payor and regulatory questions. This UR DRU 3 Team Lead writes appeal letters using UR medical directors and...nursing experience required. Minimum of 1 year of denial management experience with progressive proficiency and autonomy of reviews… 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 ... the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is the lead provider for coordination and… 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)
- …Additionally, you will facilitate cross-functional meetings to drive collaboration and efficiency, lead strategic initiatives in utilization management to ... **Details** + **Department:** Utilization Management + **Schedule:** Monday -...to enhance our processes. You'll collaborate with Market Care Management , Finance, CDI, and Physician Advisors to… more
- 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
- Scottish Rite for Children (Dallas, TX)
- …services provided, + Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization ... back their childhood! Job Posting Title: Director of Case Management and Utilization Management Location:...processes to prevent payer disputes, + Develop and provide physician education and feedback on hospital utilization ,… more
- Trinity Health (Pontiac, MI)
- …customers and community groups. **D.** **Experience** Three years recent acute care utilization management experience. Knowledge of regulations relative to ... RN licensure within the State of Michigan. Certified Professional in Utilization Review/ Management preferred. **C** **Special Skill / Aptitudes** Understanding… more
- Henry Ford Health System (Detroit, MI)
- …DNB numbers 2. Ensure correct patient status for hospitalized patients 3. Chair Utilization Management Committee: a. Reviewing outlier data, observation LOS b. ... regarding UM process, updates, and LOS initiatives 13. Ensure compliance with CMS Utilization Management Conditions of Participation (COP) 14. Attend system IPAS… 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
- Trinity Health (Springfield, MA)
- …the physician , bedside Registered Nurse, ICC and Social Worker with utilization management and clinical coordination of the patient's hospital stay. Comply ... **Mercy Medical Center** the ** Utilization Review/Appeals & Denials** **RN** performs utilization review with payers, assists the physician with level of… more
- Houston Methodist (Cypress, TX)
- At Houston Methodist, the Lead Nurse Practitioner/ Physician Assistant (NP/PA) position is responsible for functioning as a clinical leader and scholar at the ... as a preceptor by mentoring others regarding care of defined populations in resource utilization and time management . + Provides clinical guidance as a Nurse… more
- Cedars-Sinai (CA)
- …collaborative patient management under the direction of a board certified/eligible physician . The Lead PA is responsible for implementing and maintaining APP ... health, valve disorders, arrhythmia and hypertension. **Summary of Essential Duties:** The Lead Physician Assistant (PA) in the Department of Cardiac Surgery… more
- Trinity Health (Ann Arbor, MI)
- …clinical, age specific, developmental, cultural and spiritual needs. Facilitates utilization management documentation and appropriate communication with external ... knowledge of rules, regulations, policies, and procedures related to utilization management work processes and criteria. +...not meeting criteria to Case Manager and for attending physician . + Identifies to Case Manager potential home care… more
- Stanford Health Care (Palo Alto, CA)
- …one of the Nation's most prestigious Cardiothoracic Surgery teams as an APP Leader. You will lead a team of APPs as well as have your own OR and Clinic time. We ... mission one patient at a time. **A Brief Overview** Provides supervision and management of advanced practice providers (APPs) in a distinct clinical service line.… 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 ... Munson Healthcare as a whole. Reports directly to the Lead Physician Advisor for Munson Healthcare. ABOUT... Utilization Review Physicians, Inc. (ABQAURP), or American Physician Leaders in Case Management ( APLCOM)… more
- SSM Health (St. Louis, MO)
- …for Care Transformation including serving as primary lead for the governance for Utilization Management . + Oversees and is responsible for utilization ... expert, providing medical direction and oversight to care management , utilization management andclinical documentation... physician coaching for all activities of care management , utilization management , and clinical… more
- Mohawk Valley Health System (Utica, NY)
- …range of medical/clinical knowledge. + Expertise in, or willing to learn utilization management , state/federal regulations, private payer contracts. + Dedication ... PHYSICIAN ADVISOR Department: CASE MANAGEMENT Job...PREFERRED: + Certification preferred or eligibility for certification in utilization management via certifying boards within 1-2… more
- Mount Sinai Health System (NJ)
- …VMSCCC; Director, Oncology Surgical Services; the co-Directors of Radiation Oncology; and the Lead APP for Oncology + Support physician within VMG Oncology ... trust and confidence with utmost integrity + Ability to lead change and build consensus to support change +...support VHS initiatives in cost containment, product standardization, resources utilization and supply chain management (HIM Queries,… more
- SSM Health (St. Louis, MO)
- …transformation including serving as primary lead for the governance for utilization management . + Recruits, engages, develops, leads, and manages assigned ... expert and provides medical direction and oversight to care management , utilization management and clinical... physician coaching for all activities of care management , utilization management , and clinical… more
- UCLA Fielding School of Public Health (Los Angeles, CA)
- Faculty Transfusion Medicine and Patient Blood Management Physician Apply now to Faculty Transfusion Medicine and Patient Blood Management Physician Job ... overview Position title: Faculty Transfusion Medicine and Patient Blood Management Physician Salary range: The posted UC...transfusion medicine, and with the skills and interest to lead and grow a robust patient blood management… more