- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Utilization Review Clinical Review (CR) 3 Team Lead will assist the Director of UR and Associate Director of UR with daily staff ... experience is required. Must possess comprehensive and broad knowledge of complex clinical and medical concepts and demonstrate overall proficiency in clinical … more
- Kepro (AR)
- …on review of clinical records. Preferred Qualifications/Experience: + Utilization Review / Utilization Management experience. + Clinical quality ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… more
- Hackensack Meridian Health (Hackensack, NJ)
- …population and Hackensack UMC. These include but are not limited to utilization review ,** **hospital reimbursement, clinical compliance, case management, ... **Overview** **The Utilization Review Physician collaborates with the...direction and support regarding CMS & NJDOH regulations governing Utilization ** **Management & Clinical documentation.** **b. Oversight… more
- Hackensack Meridian Health (Hackensack, NJ)
- …patient population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, ... **Overview** The Senior Utilization Review Specialist collaborates with the...direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of care and promoting ... with questionable medical necessity to Physician Advisor for determination. + Review clinical and diagnostic interventions for appropriateness and timeliness… more
- Billings Clinic (Billings, MT)
- …/ Management RN. This position is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization . Coordinates with ... prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings Clinic (Billings Clinic… more
- New York State Civil Service (New York, NY)
- …(including all language parenthetic) Duties Description As a Utilization Review Coordinator, your duties will include:* Reviewing clinical records for ... NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), New York State Psychiatric Institute, P25685 Occupational Category… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services...and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General… more
- Behavioral Center of Michigan (Warren, MI)
- Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex ... clinical data and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart and records … more
- The Arora Group (Bethesda, MD)
- …LPN certification is required. + Experience: Requires a minimum of 2 years of clinical and utilization review experience or any combination of education ... Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a...patients and their families and employee satisfaction. + Perform clinical reviews to assess medical necessity of broad range… more
- Sutter Health (Berkeley, CA)
- …and others to ensure appropriate utilization and quality care through utilization review , tracking and evaluation and objectively compare criteria with ... nursing staff and other departments regarding documentation required for utilization review activities and processes. Collaborate with medical, nursing… more
- Covenant Health Inc. (Louisville, TN)
- Overview Utilization Review Coordinator, Quality Management Full Time, 80 Hours Per Pay Period, Day Shift Peninsula Overview: Peninsula, a division of Parkwest ... to end of approved number of authorized days, reviews clinical justification for continued stay and assigns further days,...or retrospective utilization data. + Monitors current utilization review criteria and length of stay… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Sharp HealthCare (San Diego, CA)
- …Professional (AHA BLS Healthcare) - American Heart Association; California BBS Licensed Clinical Social Worker (LCSW) - CA Board of Behavioral Sciences; California ... practices. **What You Will Do** Perform admission and concurrent review of patients, based upon needs regardless of payor...CA Board of Registered Nursing **OR** California BBS Licensed Clinical Social Worker (LCSW) - CA Board of Behavioral… more
- CaroMont Health (Gastonia, NC)
- …RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal ... NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case...Case Management preferred. Minimum of three years experience in clinical area with clinical review … more
- Elevance Health (Norfolk, VA)
- …Requirements:** + Requires a HS diploma or equivalent and a minimum of 2 years of clinical or utilization review experience and minimum of 1 year of managed ... **Title:** Licensed Utilization Review II **Location** : This...appropriate and consistent administration of plan benefits through collecting clinical information required to preauthorize services, assess medical necessity,… more
- Trinity Health (Silver Spring, MD)
- …the activities of RN Case Managers for in inpatient care coordination and utilization review . Oversees interactions of staff with outside activities and agencies ... an acute healthcare setting required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At least 5-7… more
- Actalent (San Bernardino, CA)
- Description: As a part of the Utilization Management team the Utilization Review RN is a member of the Care Coordination team. The goal of care coordination ... to acute inpatient stay and post-acute facility stay. The Utilization Review RN Coordinates continuing care/outside services...Acute Outpatient experience - Five or more (5+) year's clinical experience required. - Three to five (3-5) years… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well… more
- BayCare Health System (Clearwater, FL)
- …discounts and more Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review Specialist Senior **Location** Clearwater | Clinical | Part ... and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and compassionate… more