- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital … more
- Logan Health (Kalispell, MT)
- …lead the way as our Manager of Clinical Documentation Integrity (CDI) & Utilization Review ! This role is ideal for a collaborative RN leader who understands ... You'll Be Doing: As the Manager of CDI & Utilization Review , you will be responsible for...RN experience to guide teams, support providers, and strengthen clinical documentation and utilization practices, we invite… more
- Martin's Point Health Care (Portland, ME)
- …since 2015. Position Summary The Supervisor is responsible for day-to-day operations of the utilization review clinical team, in the areas of authorization ... review processes. + Assists in performing utilization reviews in a clinical capacity when...in a managed care setting including utilization review + RN experience in a clinical … more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …and may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating ... evidence-based practice *Quality of Practice*: * Promotes quality through evidence-based utilization review processes and actively contributes to performance… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional Care Team.This is a full-time role and will be required to work ... this position: *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include… more
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient...+ Staff Acquisition and Support: Leads and manages the utilization review staff and function for the… more
- Integra Partners (Troy, MI)
- …hours, with additional availability as operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director(s), ... Oversight + Provide day-to-day clinical leadership and oversight to the Utilization Review Medical Director(s) and clinical UM team. + Ensure consistent,… 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
- New York State Civil Service (Syracuse, NY)
- …from outside or within State Service can apply.As a Utilization Review Coordinator, your duties will include:* Reviewing clinical records for completeness ... NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), Hutchings Psychiatric Center, P26038 Occupational Category Health… 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
- St. Peters Health (Helena, MT)
- The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN supports the UR RN Coordinator and other UR team members in ... providing all identified utilization review functions for the organization to...admission status and confirm treatment goals, treatment plan, and clinical mileposts used to advance the treatment plan. 12.… more
- UTMB Health (Webster, TX)
- …assigned as needed. + Participates in research activities/projects + Provides assistance regarding clinical issues to non-nursing utilization review staff + ... Utilization Review Case Mgr - CMC... Utilization Review Case Mgr - CMC - Clear Lake...complicated treatment plans through multidisciplinary conferences and medical record review . + Facilitates clinical care progression of… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review - Case Management - 2506004107 Description : Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse ... care and appropriate level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as needed. (5% daily,… more
- Spectrum Billing Solutions (Skokie, IL)
- …in the most efficient and streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will ... utilize his or her knowledge and skills to review clinical information and obtain initial and... information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and… more
- Integra Partners (Troy, MI)
- …funded programs; no current or past OIG or state sanctions + Experience performing utilization management or clinical review activities + Strong written and ... The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support… more
- University of Utah Health (Salt Lake City, UT)
- …LOS, expected cost, or over/under- utilization of resources. + Performs verbal/fax clinical review with payer as determined by nursing judgment and/or ... stay review . + Communication to third-party payers for initial and concurrent clinical review . + Reviews patient chart to ensure patient continues to meet… more
- Community Health Systems (Franklin, TN)
- …to secure timely authorizations and reduce potential denials, utilizing input from the Utilization Review Clinical Specialist. + Monitors and updates case ... **Job Summary** The Utilization Review Coordinator ensures efficient and...activities. This role collaborates with payers, hospital staff, and clinical specialists to secure timely authorizations for hospital admissions… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible ... for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD) treatment at… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager, you...UR and the analysis, resolution, monitoring & reporting of clinical denials. + Maintains current knowledge of payer contract… more
- George C. Grape Community Hospital (Hamburg, IA)
- Quality/ Utilization Review Nurse Position Summary: The Quality/ Utilization Review Nurse is responsible for evaluating the medical necessity, ... to infection prevention protocols and regulatory compliance. Key Responsibilities: * Utilization Review : o Conduct concurrent and retrospective reviews of… more