- Northeast Georgia Health System, Inc (Braselton, GA)
- …in order for completion of the pre-certification process.Works in conjunction with Physician offices, Case Management, Utilization Review , and patients ... health of our communities. About the Role:Job SummaryUnder the supervision of the Utilization Review Manager, this position is responsible for ensuring the… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** The Senior Utilization Review Physician Specialist collaborates with the healthcare team in the management and resolution of activities that ... patient population and HackensackUMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- BayCare Health System (Cotton Plant, AR)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Denials Specialist - Utilization Review responsibilities include:** + Timely reviews ... year Medicaid/Medicare experience. Equal Opportunity Employer Veterans/Disabled **Position** Denials Specialist - Utilization Review **Location**… 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
- HonorHealth (Scottsdale, AZ)
- …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Fairview Health Services (St. Paul, MN)
- …meets regulatory requirements. Participates in interdisciplinary communication related to utilization review issues. Educates on status. Provides all ... M Health Fairview has an immediate opening for a Utilization Management Specialist RN. This position provides...+ Current RN licensure in MN + 3-5 years utilization review or case management experience in… 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 will facilitate, coordinate, and approve… more
- Cleveland Clinic (Weston, FL)
- …Miami-Fort Lauderdale metro area and remains a top hospital in Florida. As a Utilization Management (UM) Specialist , you will work under the general supervision ... of the UM Team Manager to perform UM activities which include admission review , concurrent review , retrospective chart review and clinical systems review … more
- University of Virginia (Charlottesville, VA)
- As a Medication Utilization , Formulary, and Policy Specialist , you will play a crucial role in optimizing medication management practices UVA. The primary focus ... position is to manage the completion of formulary activities, support medication utilization projects, and ensure timely policy management within the department of… more
- Providence (Santa Rosa, CA)
- … performance/behavioral deficiencies as requested0 + Assists in formal Peer Review activities. + Prepares physician employment agreements for physicians ... for Health System and clinics. + Effectively obtains, interprets, and analysis physician information and utilization data. + Communicate regularly with referring… more
- Huron Consulting Group (Chicago, IL)
- …as the expert you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring the appropriate ... to facilitate optimal patient outcomes while managing healthcare costs. The Utilization Management Specialist ensures compliance with regulatory requirements and… more
- Tufts Medicine (Burlington, MA)
- …as a physician advisor **Preferred Qualifications:** 1.Prior experience in utilization review /secondary review desired **Duties and Responsibilities:** ... , case management, and revenue cycle functions. 7.Provides clinical support to the utilization review and clinical documentation specialist for resolution of… more
- HCA Healthcare (Overland Park, KS)
- …facilitates access review audits. e) Tracks, monitors, and enhances provider utilization of HCA technologies, by offering at the elbow support and one-on-one ... personal growth, we encourage you to apply for our Sr Provider Solutions Specialist opening. We promptly review all applications. Highly qualified candidates… 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
- HCA Healthcare (Chattanooga, TN)
- …this opportunity compelling, we encourage you to apply for our Provider Solutions Specialist PRN -Parkridge opening. We promptly review all applications. Highly ... where diversity and inclusion thrive? Submit your application for our Provider Solutions Specialist PRN opening with Parkridge Medical Center today and find out what… more
- AdventHealth (New Smyrna Beach, FL)
- … physician identification and scheduling of follow-up PCP and specialist appointments for post-hospital follow up care. Ensures discharge disposition accuracy ... New Smyrna Beach **The role you'll contribute:** _The_ _Social Work Specialist intervenes with patients who have complex psychosocial needs, require assistance… more
- Ventura County (Ventura, CA)
- HS Client Benefit Specialist Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4440930) Apply HS Client Benefit Specialist Salary $44,512.49 ... of strengthening partnerships and join Ventura County as a HS Client Benefit Specialist ! WHAT WE OFFER The County of Ventura offers an attractive compensation and… more
- Hackensack Meridian Health (Hackensack, 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 RN** facilitates improvement in the overall quality, completeness and accuracy of… more
- Hackensack Meridian Health (Hackensack, 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
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Enhanced Care Management Clinical Specialist II Job Category: Clinical Department: Care Management...Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM),… more
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