- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of ... and collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital … 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 ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Medical Center Hospital (Odessa, TX)
- + Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician Advisors. + Qualifications: A. Education: Holds a current Texas… more
- Spectrum Billing Solutions (Skokie, IL)
- …Excel, billing software). + Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management ... Specialist | Insurance Specialist | UR Specialist | Revenue Cycle Utilization Review Specialist | ABA Utilization Review Specialist |… 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)… more
- TEKsystems (Los Angeles, CA)
- …Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong understanding of HMO/Medicare claims processes. ... provider and member claims for accuracy and compliance + Review and process claims in accordance with UM guidelines...RN license (California) + 2+ years of experience in Utilization Management (UM) + Hands-on experience with HMO/Medicare claims,… more
- WestCare Foundation (Henderson, NV)
- …LPN or RN and/or Bachelors or Masters level CADC/LADC with 2 years utilization review experience, preferred experience working with individuals with psychiatric ... or substance use disorder Experience and Competencies: + Proven experience in conceptualizing a case and creating a clinical impression to present to all involved and approved parties, including managed care representatives + Knowledge of CPT, ICD 9 & ICD 10… more
- BayCare Health System (Tampa, FL)
- …a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + ... + Preferred Masters in Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years in Case Management or + Required 3… 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 effective management of utilization review processes, including denials and… more
- Henry Ford Health System (Troy, MI)
- The support specialist is a support role crucial to the centralized Utilization Review team for time sensitive authorization tracking and resolution process. ... Epic preferred. Additional Information + Organization: Corporate Services + Department: Central Utilization Mgt + Shift: Day Job + Union Code: Not Applicable… more
- Deloitte (Los Angeles, CA)
- …clinical registered nurse, physician, physician assistant, case manager, clinical documentation specialist , utilization review , informatics RN, Quality, DRG ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk...financial concerns and other business controversy. A Clinical Documentation Specialist (CDS) works to ensure accuracy and completeness of… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Penn Medicine (Lancaster, PA)
- …Medicine Lancaster General Health is looking for an experienced RN to join our Utilization Management Specialist team! In this critical role, you'll advocate for ... we'd love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible...accommodation to perform the following duties:** + Complete chart review and communicate patient status medical needs with insurance… more
- AnMed Health (Anderson, SC)
- …necessity review , continued stay/concurrent review , retrospective review , bed status management, resource utilization management, regulatory compliance, ... assigned utilization management functions daily: initial, concurrent and retrospective review of the medical record with speed and accuracy for all required… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing stay.… 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
- 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...14. Collaborates with admitting physician, ED physicians, Hospitalists, Documentation Specialist , and other ancillary staff to assist with the… more
- UnityPoint Health (Cedar Rapids, IA)
- …174223 Overview This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments ... care, optimal clinical outcomes and patient and provider satisfaction. The UM Specialist provides the Utilization Management function for patients admitted to… more
- UNC Health Care (Kinston, NC)
- …support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established ... dollars and appeal win rates. 12. Assists in documentation review in the clinical documentation specialist role...experience as a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
- Katmai (Usaf Academy, CO)
- …need for inpatient/outpatient precertification. **ESSENTIAL DUTIES & RESPONSIBILITIES** + Review precertification requests for medical necessity, referring to the ... Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part...Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,… more
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