- Kelsey-Seybold Clinic (Houston, TX)
- …needs **Job Title: Utilization Review Specialist (LVN)** **Location: Remote ** **Department:** ** Utilization Management ** **Job Type: Full Time** ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to… 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...presenting after the call and documented in the case management system by the UR Review Specialist .… more
- Spectrum Billing Solutions (Skokie, IL)
- …cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing team. The UR Specialist ... in working in a cohesive and rewarding environment. This is a remote or office/home hybrid position. Responsibilities include: + Review patient admission and… more
- CVS Health (Columbus, OH)
- …as what we deliver. **Position Summary** The Analyst, Medical Cost Analytics / Utilization Management role will analytics to evaluate scenarios and make ... and support decision making. The Analyst will be regarded as a specialist , analyzing large data sets in real-time databases and developing mathematical approaches… more
- AdventHealth (Altamonte Springs, FL)
- …cause and bring about the best opportunity for fair reimbursement. The Clinical Denial Management Specialist will adhere to the AHS Compliance Plan and to all ... rebilling. . Collaborates with pre-access, patient financial services, revenue integrity, utilization management and clinical department staff to obtain further… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical ... billing with information needed to obtain payment of claims. Remote within local geography after orientation. JOB DUTIES AND...+ Prefer minimum of 2-5 years' experience in case management and/or utilization management . +… more
- Intermountain Health (Murray, UT)
- …role that combines the expertise of a Licensed and Masters Prepared Behavior Health Specialist with Utilization and Care management . This role is essential ... in care management /navigation or closely related field including: Utilization Management , discharge planning, managed care, health promotion, health… more
- Ochsner Health (New Orleans, LA)
- …Preferred - Certification in Case Management (CCM) or Certified Professional in Utilization Review, Utilization Management or Health Care Management ... of patient care as an RN. Experience in Case Management , Utilization Review and/or Discharge Planning .either...work from the following areas are not eligible for remote work position_ _: Colorado, California, Hawaii, Maryland, New… more
- BayCare Health System (Clearwater, FL)
- …foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions ... necessity of outpatient observation and inpatient stays and the utilization of ancillary services + Perform other duties as...start for up to 6 months, then eligible for remote ) + **On Call:** No **Certifications and Licensures:** +… more
- Marshfield Clinic (Marshfield, WI)
- …missions in the world!** **Job Title:** Clinical Documentation Integrity Specialist ( Remote in Wisconsin/Michigan) **Cost Center:** 101651052 HIM-Clinical ... experience in medical/surgical, critical care, emergency room, operating room, PACU, case management , or utilization review **OR** Five years hospital inpatient… more
- Jensen Hughes Inc. (Cary, NC)
- Payroll Data Specialist ( Remote ) Cary, North Carolina, United States . Remote - United States **Company Overview** At Jensen Hughes, we lead with our Purpose ... Today, our expertise extends broadly across closely related risk management fields - from accessibility consulting, risk and hazard...We are seeking a detail-oriented and organized Payroll Data Specialist with a strong focus on data entry to… more
- Aveanna Healthcare (Hayward, CA)
- …to Regional Centers and other Community Based Organizations Assist with utilization management of referrals; including follow-up communication with referral ... Bilingual Community Relations Specialist ( Remote ) ApplyRefer a FriendBack Job...Responsible for driving revenue growth and working with location management to ensure profitability, this key contributor is expected… more
- McLaren Health Care (Indianapolis, IN)
- We are looking for an Intake Specialist to join us in leading our organization forward. McLaren Integrated HMO Group (MIG), a division of McLaren Health Care ... case managers. Works with the PCP, the member and management to promote the delivery of quality services at...at the most appropriate and cost-effective setting. Monitors members' utilization patterns for identification of high-risk and under and… more
- Huntington Ingalls Industries (Fairfax, VA)
- …for a short video: https://vimeo.com/732533072 Summary: HII-Mission Technologies is seeking a remote Data Integration & Automation Specialist . In this role you ... to create more value through rapid access and comprehension than traditional data management practices. *This position can work remote . You will design and… more
- Beth Israel Lahey Health (Boston, MA)
- …you're making a difference in people's lives.** This position is available for an on-site/ remote hybrid work arrangement and a minimum of 2 days per week on-site is ... Employees must reside in MA, NH, or RI. Job Summary: The Clinical Pharmacy Specialist serves as a leader in clinical pharmacy practice in a specific clinical area,… more
- St. Luke's University Health Network (Allentown, PA)
- …a patient's ability to pay for health care. The Surgical Review Specialist prospectively reviews, validates, and audits procedure code assignment in accordance with ... lost with feedback to respective departments + Conduct concurrent review with utilization review department for post op surgical cases with potential status issues,… more
- Sierra Nevada Company, LLC (Lone Tree, CO)
- As an Earned Value Specialist , you will provide Earned Value Management implementation support to maintain industry best practices and ensure compliance with all ... conduct EVM Workshops/Trainings to enhance EVM skills within the Program Management and Business Operations communities, and provide oversight to establish program… more
- Vanderbilt University Medical Center (Nashville, TN)
- …**Responsibilities:** **Certifications:** Certified Coding Associate - American Health Information Management Association, Certified Coding Specialist - American ... Health Information Management Association, Certified Coding Specialist - Physician - American Health Information Management Association, Certified Outpatient… more
- CareFirst (Baltimore, MD)
- …Degree + Knowledge of CareFirst systems, Member/Provider Service, Claims or Utilization Management experience a plus. Managed care experience. **Knowledge, ... will support government programs lines of business. The Appeals Specialist II will be responsible for the initial analysis...and works on special projects with Appeals Nurse or Management . + Interacts regularly with and responds to internal… more
- Wider Circle (Mcallen, TX)
- Position Overview: The Outreach Specialist plays a key role in our outreach center operations, connecting with current and prospective members to promote our ... drive resilience, improve member experience and engagement, and reduce inappropriate utilization and has been published in peer-reviewed literature. Today, Wider… more