- 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
- Munson Healthcare (Traverse City, MI)
- …families, interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic ... State of Michigan. + Minimum of three years clinical experience required. Previous utilization review and/or case management in a hospital or insurance industry… 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
- 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
- Bakersfield Behavioral Healthcare Hospital (Bakersfield, CA)
- …leadership, teamwork, and communication skills. ESSENTIAL DUTIES The primary responsibility of the Utilization Review Specialist is to review medical ... of candidates. Education Associates Degree preferred Minimum Work Experience Utilization Review experience preferably in a behavioral/psychiatric healthcare… more
- Mount Sinai Health System (New York, NY)
- …Operating Room Surgical Scheduling, Mount Sinai West - Full Time, Days** The Utilization Review Specialist coordinates scheduling of all surgical/endoscopic ... **Job Description** ** Utilization Review Admission Specialist ...and operating roaom time. 7. Checks credentials system for physician 's delineation of privileges for equipment and/or procedures according… more
- Cleveland Clinic (Vero Beach, FL)
- …or visit. Some of the responsibilities of a Utilization Management Specialist include medical record review , providing clinical information to payers, UM ... May design and initiate special projects as supervised by the Team Manager. Utilization Management Specialist Join our team at Cleveland Clinic Indian River… 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
- Trinity Health (Pontiac, MI)
- …RN licensure within the State of Michigan. Certified Professional in Utilization Review /Management preferred. **C** **Special Skill / Aptitudes** Understanding ... care utilization management experience. Knowledge of regulations relative to utilization review . Knowledge of Federal, State and Local regulations sources.… more
- Sanford Health (ND)
- …also acceptable, ie Certified Coding Specialist (CCS), Certified Coding Specialist - Physician based (CCS-P), Certified Professional Coder (CPC), Certified ... Details** Opportunity to work remotely. **Job Summary** Monitors the utilization of resources, risk management and quality of care...is not exceeded without due notice to the attending physician . May also need to notify physician … more
- St. Luke's University Health Network (Allentown, PA)
- …registrations and/or physician queries + Serves as liaison between Physician Advisor/Medical Director, Finance, Utilization Review Department and ... patient's ability to pay for health care. The Surgical Review Specialist prospectively reviews, validates, and audits...lost with feedback to respective departments + Conduct concurrent review with utilization review department… more
- Mohawk Valley Health System (Utica, NY)
- … regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of...and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides… more
- Alameda Health System (San Leandro, CA)
- … utilization and an appropriate level of care. 5. Coordinates all utilization review functions, including response to payor requests for concurrent and ... Care Management Clinical Appeals Specialist + San Leandro, CA + Finance +...of Case Management experience in an acute setting or utilization review at a medical group or… more
- HCA Healthcare (Denver, CO)
- …this opportunity compelling, we encourage you to apply for our Provider Solutions Specialist II opening. We promptly review all applications. Highly qualified ... organization that invests in you as a(an) Provider Solutions Specialist II? At HCA HealthOne, you come first. HCA...(PSS II) applies advanced knowledge to problem resolution for physician -facing technologies. They serve as an escalation point for… more
- HCA Healthcare (San Antonio, TX)
- …opportunity compelling, we encourage you to apply for our Provider Solutions Specialist opening. We promptly review all applications. Highly qualified candidates ... where diversity and inclusion thrive? Submit your application for our Provider Solutions Specialist opening with ITG - San Antonio Division today and find out what… more
- WMCHealth (Valhalla, NY)
- …and coding principles and guidelines; good knowledge of healthcare delivery system, utilization review , case review and quality improvement practice ... Network CDI Physician Champion Company: NorthEast Provider Solutions Inc. City/State:...processes. The Physican Champion will provide clinically based concurrent review of patient medical records to ensure documentation accurately… more
- Hackensack Meridian Health (Neptune, NJ)
- …ED inpatient admissions and observations as specified by the facility's Utilization Management/ Review Committee for documentation completeness and compliance ... and serve as a leader of positive change. The **Clinical Documentation Specialist ** facilitates improvement in the overall quality, completeness and accuracy of… more
- Veterans Affairs, Veterans Health Administration (Spokane, WA)
- …of Geriatrics Rehabilitation Extended Care(GREC) Service, Mann Grandstaff VAMC. The CLC Staff Physician and Palliative Care Specialist will serve in three main ... Summary The Palliative Care Physician is assigned to the Community Living Center...the CLC for hospice/palliative care. Responsibilities This palliative care specialist will also contribute to and support the growth… more
- HCA Healthcare (Dallas, TX)
- …staff performance evaluations. + Acts as manager in charge as assigned. + Provides review and guidance on physician order sets and other evidenced based ... in daily multidisciplinary and bedside rounds + Completes drug utilization reviews to promote rational drug therapy and implement...we encourage you to apply for our Clinical Pharmacist Specialist BMT PRN opening. We promptly review … more
- Sharp HealthCare (San Diego, CA)
- …be utilized for ongoing professional practice evaluation and re-credentialing.Collaborates with physician leadership to establish meaningful peer review criteria ... **What You Will Do** The purpose of the Sr. Performance Improvement Specialist is to improve clinical outcomes including responsibilities relating to leading teams… more
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