- Alameda Health System (Oakland, CA)
- …each individual in the classification. Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. ... utilization reviews and determine program improvements. Develop and implement utilization review policies and procedures in accordance with industry… more
- Defense Health Agency (San Antonio, TX)
- Overview Physician (Internal Medicine) Joint Base San Antonio Time to invest in some new footwear because if you're San Antonio-bound, you'd better show up in boots ... treatment and management of patients and Internal Medicine Clinic (IMC) with the full range of conditions encountered in primary care, and in providing assistance… more
- Monogram Health (Jacksonville, FL)
- Monogram Health is seeking a full -time physician , specialized in palliative care, to join the team due to continued nationwide growth.?This physician will be ... suite of technology-enabled clinical services, including case and disease management, utilization management and review , and medication therapy management… more
- Catholic Health System (Buffalo, NY)
- Trinity Medical, WNY, is seeking a dedicated full time Hematology/Oncology Physician in Buffalo, NY, a diverse and family friendly community on the shores of ... Lake Erie. This Physician shall be Board Certified/Eligible in Hematology and Medical...Holistic development of patient treatment plans, readily available for review in the EHR. 12. Utilization of… more
- Buckeye Community Health Plan (Thornville, OH)
- … management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. Identifies utilization review studies and evaluates adverse trends in utilization of… more
- Christus Health (Texarkana, TX)
- …therapy department. Participates in medical chart peer review , case record review and utilization review as deemed necessary. Assumes responsibility ... goals, plans programs and treats patients according to the physician 's orders; maintains required records and notes; assists with...hospital with proof of indicated requirements. BCLS certification. Work Schedule: 5 Days - 8 Hours Work Type: Full … more
- HCA Healthcare - Chief Medical Officer (San Antonio, TX)
- …a data-driven environment of quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care in ... as a consultant to hospital Medical Staff Services regarding physician credentialing, utilization , and quality profiling. Serves...member of hospital's peer review committees as requested. Please click here to view the full job… more
- BoldAge PACE (Evansville, IN)
- … management, quality management, performance improvement, pharmacy and therapeutics, peer review , credentialing, and physician leadership matters. Minimum of 3 ... aligned with regional regulations and BoldAge PACE policies. Acts as collaborating physician to advanced practice providers as necessary and appropriate by local… more
- Monogram Health (Fort Myers, FL)
- …all clinical policies, procedures and guidelines with Monogram employees and our physician partners Represent Monogram as a clinical leader to health plans, ... IT and data tools to report, monitor, and improve quality and utilization Assist Practice Medical Executives to conduct retrospective reviews of hospitalizations and… more
- Fresenius Medical Care (Fayetteville, NC)
- …staff in problem solving. PHYSICIANS: Facilitates the application process for physician privileges and compliance with FMS Medical Staff By-Laws. Responsible for ... strong Director and physician relationships and facilitating staff relationships with physicians. Ensures...manuals. Accountable for completion of the Annual Standing Order Review and ICD coding. Checks correspondence whether electronic, paper… more
- Hackensack Meridian Health (Hackensack, NJ)
- The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical ... Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case...Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package. The… more
- Hackensack Meridian Health (Hackensack, NJ)
- **The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of ... Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case...Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package. The… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE ... see comprehensive information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're… more
- The County of Los Angeles (Los Angeles, CA)
- …Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician member of the ... UTILIZATION REVIEW NURSE SUPERVISOR II Print...$177,314.88 Annually Location Los Angeles County, CA Job Type Full time Job Number Y5126D Department HEALTH SERVICES Opening… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... this position is able to cover a multitude of utilization review functions through point of entry,...process improvements). **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates with the physician and all members of the interprofessional health care… more
- Emory Healthcare/Emory University (Decatur, GA)
- …_,_ and leadership programs + And more **Description** We're seeking a **Clinical Utilization Review Nurse Preceptor (Registered Nurse / RN)** . This individual ... will be responsible for training, mentoring, and coaching for the Utilization Review Department and must be an expert in the utilization review functions… more
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 251119-5613FP-001 Location Middletown, CT Date Opened 12/11/2025 12:00:00 AM Salary ... Campus Hospital (https://portal.ct.gov/dcf/solnit-center/south) - is accepting applications for a Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=) (REGULATORY) position,… 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
- Integra Partners (Troy, MI)
- …operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director(s), ensures consistent application of criteria, ... Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director's responsibilities include but are not… more
- Sedgwick (Cincinnati, OH)
- …provider's office. + Utilizes evidence-based criteria and jurisdictional guidelines to form utilization review determinations. + Pursues Physician Advisor ... Fortune Best Workplaces in Financial Services & Insurance RN Utilization Review **Join us in a hybrid...6% you save. + 4 weeks PTO your first full year. **NEXT STEPS** If your application is selected… more
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