• Physician Utilization Review

    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
    Hackensack Meridian Health (08/19/24)
    - Save Job - Related Jobs - Block Source
  • Utilization Review Specialist

    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
    CaroMont Health (10/26/24)
    - Save Job - Related Jobs - Block Source
  • Utilization Review Specialist

    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
    Sutter Health (10/24/24)
    - Save Job - Related Jobs - Block Source
  • Utilization Review Admission…

    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
    Mount Sinai Health System (09/04/24)
    - Save Job - Related Jobs - Block Source
  • Utilization Management Specialist NE

    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
    Cleveland Clinic (10/31/24)
    - Save Job - Related Jobs - Block Source
  • Utilization Management Coordinator…

    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
    Trinity Health (10/09/24)
    - Save Job - Related Jobs - Block Source
  • Surgical Review Specialist

    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
    St. Luke's University Health Network (10/31/24)
    - Save Job - Related Jobs - Block Source
  • Senior Provider Solutions Specialist

    HCA Healthcare (Kansas City, MO)
    …access review audits.** **e) Tracks, monitors, and enhances provider utilization of HCA technologies, by offering at the elbow** **support and one-on-one ... compelling, we encourage you to apply for our Sr Provider Solutions Specialist opening. We promptly review all applications. Highly qualified candidates… more
    HCA Healthcare (10/24/24)
    - Save Job - Related Jobs - Block Source
  • Provider Solutions Specialist

    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
    HCA Healthcare (10/26/24)
    - Save Job - Related Jobs - Block Source
  • Physician Advisor

    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
    Mohawk Valley Health System (09/18/24)
    - Save Job - Related Jobs - Block Source
  • Network CDI Physician Champion

    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
    WMCHealth (10/30/24)
    - Save Job - Related Jobs - Block Source
  • Clinical Documentation Specialist , RN…

    Hackensack Meridian Health (Edison, NJ)
    …ED inpatient admissions and observations as specified by the facility's Utilization Management/ Review Committee for documentation completeness and compliance ... **Overview** The **Clinical Documentation Specialist RN** facilitates improvement in the overall quality,...and computer system as appropriate. + Extensively reviews all physician and clinical documentation, lab results, diagnostic information and… more
    Hackensack Meridian Health (10/12/24)
    - Save Job - Related Jobs - Block Source
  • Sr Specialist -PI-Quality/Safety - Sharp…

    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
    Sharp HealthCare (11/08/24)
    - Save Job - Related Jobs - Block Source
  • Provider Engagement Specialist ACO/PO

    Commonwealth Care Alliance (Farmington, MI)
    …works closely with participant providers within the organization's ACO and/or Physician 's Organization. The Provider Engagement Specialist will conduct reviews ... and define scope for on-site review and review period. + Work with physician 's office...Educate practices how PCMH capabilities lead to improved quality, utilization , and cost performance. + Other duties as assigned.… more
    Commonwealth Care Alliance (10/17/24)
    - Save Job - Related Jobs - Block Source
  • Care Coordination Specialist

    Hackensack Meridian Health (Neptune, NJ)
    …inclusive of free text fields, to support the case management, utilization review process. + Retrieves information for the Physician Advisors as needed. + ... A day in the life of a **Care Coordination Specialist ** at **Hackensack Meridian** **_Health_** includes: ** Utilization ...+ Verifies admission and discharge date information. + Updates Utilization Review RN needed for payors. +… more
    Hackensack Meridian Health (10/24/24)
    - Save Job - Related Jobs - Block Source
  • Rehab Specialist

    HCA Healthcare (San Antonio, TX)
    …acute inpatient rehabilitation services prior to returning home. The Clinical Rehabilitation Specialist will review these patients daily until they have strong ... clinical evidence to request a physician order for a formal pre-admission assessment for acute...growth, we encourage you to apply for our Rehab Specialist opening. We promptly review all applications.… more
    HCA Healthcare (08/15/24)
    - Save Job - Related Jobs - Block Source
  • Pharmacy Benefits Specialist

    Novant Health (Winston Salem, NC)
    …BENEFITS SPECIALIST ** Novant Health is an integrated system of physician practices, hospitals, outpatient centers, and more - each element committed to ... the way on their journey to health and wellness. The Pharmacy Benefits Specialist at Novant Health works closely with the Pharmacy Benefits Manager (PBM), Benefits… more
    Novant Health (09/28/24)
    - Save Job - Related Jobs - Block Source
  • RN- Clinical Admission Specialist

    Carle (Urbana, IL)
    …on each applicable transfer, completes documentation per hospital guidelines.* Performs admission Utilization review on all direct admissions & transfers to ... RN- Clinical Admission Specialist + Department: Transfer Coordination - CMH +...EMTALA guidelines). Actively collaborates with providers, nursing, and case management/ utilization management to ensure appropriate patient placement for optimal… more
    Carle (11/01/24)
    - Save Job - Related Jobs - Block Source
  • Lead Advanced Practice Provider (Nurse…

    Stanford Health Care (Palo Alto, CA)
    …one (1) year of experience as a licensed advanced practice provider: ( Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or Certified Registered ... Provides clinical direction and education, works closely with operational and physician leaders, and has oversight of hiring, termination, and professional growth… more
    Stanford Health Care (09/09/24)
    - Save Job - Related Jobs - Block Source
  • Clinical Pharmacy Specialist (Pain…

    Veterans Affairs, Veterans Health Administration (Orlando, FL)
    …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities The duties and responsibilities of the Clinical Pharmacy Specialist (Pain Management) may include, but are not limited to, any of the following:… more
    Veterans Affairs, Veterans Health Administration (10/29/24)
    - Save Job - Related Jobs - Block Source