- 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 Utilization Review with daily staff mentoring, leadership and resource provision....and provides feedback/mentorship to UR CR I as to review , payor and regulatory questions. This UR DRU 3… more
- WellSpan Health (York, PA)
- … management, denials and Prior Authorization activities to ensure utilization review activities are conducted timely in accordance with internal ... the utilization management process for preauthorization, concurrent review , denials and appeals for System acute...Serves as point of contact for System acute care utilization review issues and resolutions with payers.… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …+ 5 years of RN experience preferred. + Minimum Three (3) years utilization management experience preferred + Denials management experience preferred. + Care ... vacation, adoption assistance, annual bonus eligibility, and more! **Responsibilities** The Denials RN is responsible and accountable for receiving, processing and… more
- CommonSpirit Health (Sacramento, CA)
- …community. **Responsibilities** **This is a remote position.** **Summary** The Utilization Management Physician Advisor II conducts clinical case reviews referred ... for assuring quality patient care and effective and efficient utilization of health care services. This position will be...This position will be a part of the specialized Denials Management team. This individual meets with case management… more
- Insight Global (Skokie, IL)
- …. Skills and Requirements 3+ years experience as a utilization review nurse Experience reviewing and analyzing denied ... As a Clinical Denials Specialist you will be working with the denials team to review and analyze denials from a clinical perspective. This person will be… more
- Kaleida Health (Buffalo, NY)
- …conventions and insurance / managed care practices including but not limited to: utilization review , RAC, MAC, Q10, clinical and DRG denial management required. ... Revenue Cycle Admin **Job Description:** The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to the Clinical Revenue… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** **The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the ... patient population and HackensackUMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- BayCare Health System (Clearwater, FL)
- …responsibility and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and ... compassionate team. **The Utilization Review Specialist Senior responsibilities include:** +...Critical Care or Emergency Service **Facility:** BayCare Health System, Utilization and Denials Mgmt-MPH **Location:** **Morton Plant**… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …1. Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted ... for appropriate status determination. 2. Ensures compliance with principles of utilization review , hospital policies and external regulatory agencies, Peer… more
- Behavioral Center of Michigan (Warren, MI)
- …for appeal of denials . Responds to complaints per UR guidelines. Maintains utilization review and appeal logs, as needed. Analyzes patient recrods and ... Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex… 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 ... clinical nursing staff and other departments regarding documentation required for utilization review activities and processes. Collaborate with medical, nursing… 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 ... team to insure optimal reimbursement for services provided. + Review concurrent denials from third party payers...transition to alternative levels of care. + Perform concurrent utilization review applying identified criteria at prescribed… 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 ... practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case Management preferred. Minimum… more
- Trinity Health (Columbus, OH)
- **Employment Type:** Part time **Shift:** **Description:** ** Utilization Review RN, Case Management** **Why Mount Carmel?** With five hospitals ... the Mount Carmel College of Nursing **About the job:** The **RN Case Manager, Utilization Review ** ensures that services are delivered in a manner that balances… more
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review , under the supervision and in collaboration with the ... activities of hospital staff in inpatient care coordination and utilization review . Oversees interactions of staff with... while supporting the HCH mission. Collaborates with the denials prevention and management staff to ensure a low… 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 ... while supporting the HCH mission. + Assists with the denials prevention and management staff to ensure a low...in an acute healthcare setting. + Designation Changes and Utilization Review + Knowledge of pertinent regulatory,… more
- Baptist Memorial (Jackson, MS)
- Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and appropriateness of healthcare services and treatment as prescribed ... by utilization review standards. The UR Nurse works...Communicates with physician advisors related to status concerns or denials + Updates auth/cert screen in the electronic medical… more
- Hartford HealthCare (Torrington, CT)
- …of the Inpatient Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the IP ... Psychiatry Patient Care Team to assure Utilization Review activities on a 17 bed...secure reauthorization for care; and follow up on insurance denials . Requires in-depth knowledge of behavioral health services in… more
- Ascension Health (Milwaukee, WI)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more