- Corewell Health (Royal Oak, MI)
- …3 years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + ... patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2.… more
- Northwell Health (Huntington, NY)
- …in case management and clinical pathways, variance analysis and trending, quality management/ utilization review and home care/discharge planning, preferred. ... concurrent utilization management using Interqual criteria. + Conducts chart review for appropriateness of admission and continued length of stay. + Contacts… more
- Corewell Health (Dearborn, MI)
- …3 years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + ... for groups of patients as it relates to disease management, resource utilization , access, discharge planning, quality, service and efficiently across the continuum.… more
- BrightSpring Health Services (Louisville, KY)
- …therapy from an accredited or approved school.* Two years of experience in health care utilization review or home care.* Two years prior home ... Audits patients records for quality and compliance per applicable home health regulations for submission for pre-claim review... home health regulations for submission for pre-claim review process of Review Choice Demonstration.* Audits… more
- BayCare Health System (Largo, FL)
- …within the area of responsibility + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol + Oversees and ... **There's home care and then there's BayCare HomeCare!** Every...Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization … more
- Health Advocates Network (Harrisburg, PA)
- …the field of medical assistance (MA), health care services, human services, long term care, utilization review , or knowledge of home care Knowledge of and ... setting, behavioral health setting, drug and alcohol setting, managed care, quality management/ utilization review or other related clinical experience; or An… more
- BayCare Health System (Dunedin, FL)
- …the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + Oversees and ... **There's home care and then there's BayCare HomeCare!** It...Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization … more
- BayCare Health System (Largo, FL)
- …the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + Oversees and ... **There's home care and then there's BayCare HomeCare!** At...Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization … more
- BayCare Health System (Bradenton, FL)
- …the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + Oversees and ... **There's home care and then there's BayCare HomeCare!** Join...Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization … more
- ChenMed (St. Louis, MO)
- …of 2 years' clinical work experience required + A minimum of 1 year of utilization review and/or case management, home health, discharge planning experience ... and discharge planning. **KNOWLEDGE, SKILLS AND ABILITIES:** + Knowledge of Utilization Review (UR) and discharge planning + Strong interpersonal and… 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 ... clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and...+ Flexible work environment - You can work from home , hybrid or fully in office. + Competitive Salary… more
- Munson Healthcare (Traverse City, MI)
- …interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic work ... State of Michigan. + Minimum of three years clinical experience required. Previous utilization review and/or case management in a hospital or insurance industry… more
- Henry Ford Health System (Detroit, MI)
- The Medical Director of Utilization Review is responsible for the medical oversight of activities related to appropriateness of Henry Ford Hospital (HFH) ... and continued stays of inpatients. The Medical Director of utilization review will ensure the most efficient...and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care 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 ... of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians....compassionate team. **The Utilization Review Specialist Senior responsibilities include:** +… more
- Centene Corporation (Madison, WI)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... role have the flexibility to work remotely from their home anywhere within the Eastern or Central time zone...or Central time zone **Position Purpose:** Performs a clinical review and assesses care related to mental health and… more
- Providence (Kodiak, AK)
- …for discharge planning, admission to swing bed and case management including utilization review in accordance with Providence philosophy, objectives, policies, ... procedures and standards. The Case Manager/RN Navigator partners with the Utilization Review nurse, patients, physicians, and interdisciplinary team to ensure… more
- Providence (Mission Hills, CA)
- **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records ... strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The … more
- Stanford Health Care (Palo Alto, CA)
- …and Abilities** + Knowledge of principles and best practices of case management, utilization review , social work, care coordination and discharge planning. + ... Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation, partnerships,… more
- HCA Healthcare (Ogden, UT)
- …Apply Today! **Job Summary and Qualifications** The Mental Health Professional/ Utilization Review role primarily involves reviewing medical records ... guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... BE ONSITE FOR THE 1ST WEEK AND THEN WILL BE DEPLOYED TO WORK FROM HOME . WILL PROVIDE THE EQUIPMENT. + NICE TO HAVE skill sets/qualities: Working knowledge of… more
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