- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for ... to the hospital as well as continued stay. The Utilization Review Clinical Specialist supports and coordinates...and payer requirements. These discussions aim to help the UR Clinical Specialist understand the reason for admission and… more
- San Antonio Behavioral Health (San Antonio, TX)
- …inefficiencies or deviations from standards of care. * Maintain accurate and detailed records of utilization review activities and outcomes. * Prepare ... The Utilization Review Coordinator conducts utilization...appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with patients' treatment. Reviews… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Manager of Utilization Review oversees a team of utilization review nurses and coordinators, ensuring compliance with clinical ... regulatory standards, and enhancing the overall utilization review process to optimize patient care... management program, denials and appeals activities. Works with UR Director, UR Senior Director, and Payor… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for ... documentation from the physician(s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if...and documented in the case management system by the UR Review Specialist. + In the event… more
- Desert Parkway Behavioral Healthcare Hospital (Las Vegas, NV)
- …that all days are authorized and identify denied days, coordinate with Director of Utilization Review and add to Denial Tracker when appropriate. Monitor and ... assigned to the case when completed. Appeals As directed by UR Director, retrieves patient records from EMR, prints chart, and forwards chart to staff… more
- Behavioral Center of Michigan (Warren, MI)
- …and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart and records clinical information ... Reviews patient recrods and evaluates patient progress. Performs continuing review on medical records and identification and...requests for appeal of denials. Responds to complaints per UR guidelines. Maintains utilization review … more
- HonorHealth (Scottsdale, AZ)
- …communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …mental health and co-occurring psychiatric and substance abuse conditions. POSITION TITLE: Utilization Review Clinician PAY RANGE: $31.00-$49.24 PER HOUR REPORTS ... TO: Director of Utilization Review DESCRIPTION OF POSITION: Work as... records of appeals. + Recordkeeping: Maintains appropriate records (AIS, UR forms/charts, Peer to Peer… more
- Prime Healthcare (Passaic, NJ)
- …and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and ... accredited institution in a Health and Human Services field is highly preferred.2. Utilization Review experience is highly preferred.3. Must meet the performance… more
- Reno Behavioral Healthcare Hospital (Reno, NV)
- The UR Specialist reviews and monitors patients' utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties ... include providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency of medical services and procedures. + Performs… more
- Dartmouth Health (Lebanon, NH)
- Overview Utilization Review (RN) - Remote Works with physicians and multidisciplinary team members to develop a plan of care for assigned patients. Ensures ... towards desired outcomes by monitoring care through assessments and/or patient records . Identifies and resolves barriers that hinder effective patient care. Actively… more
- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... and educate to improve outcomes. -Assists with preparation and presentation of utilization review monitoring/trending reports for review with physicians… more
- Tufts Medicine (Burlington, MA)
- …personnel in the Clinical Documentation Improvement, HB/PB Coding, HIM Operations, and Utilization Review ( UR ) departments while implementing enterprise-wide ... direct standardization of activities across localized CDI, Coding, and Utilization Review departments. They will provide input...12. Ensures quality and quantity of documentation in medical records for UR . 13. Attends treatment staff… more
- Prime Healthcare (Kankakee, IL)
- …and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and ... and completes the clinical reviews for all patient medical records while working closely with CMO (Chief Medical Officer)....PA, or Nursing Graduate required. 2. Three years of Utilization Review experience as a Medical … more
- University of Rochester (Rochester, NY)
- …any investigations and corrective action plans as it relates to HazD handling and utilization within the health system. Documents the review of the quality ... time Scheduled Weekly Hours: 40 Department: 100124 Environmental Health & Safety Work Shift: UR - Day (United States of America) Range: UR URG 111 Compensation… more
- Houston Methodist (The Woodlands, TX)
- …with the evaluation of the hospital's Utilization Management Program, including annual review and revision of the hospital's UR plan. + Contacts physicians ... resources. The Physician is a key member and leader of the hospital's utilization review /management committee, which is charged with regulatory goals of ensuring… more
- University of Rochester (Strong, AR)
- …Enrollment & Outreach, Financial Assistance, Registration and Insurance Management, Utilization Management, Social Work, Patient Accounts, Medical Records , ... Type: Full time Scheduled Weekly Hours: 40 Department: 500183 Financial Counseling&Outpt Reg Work Shift: UR - Day (United States of America) Range: UR URC 205 H… more
- Trinity Health (Syracuse, NY)
- …12-day shifts. Emergency department experience preferred. **Position Purpose:** The Registered Nurse Utilization Review ( UR ), Clinical Care Manger (CCM) ... actively manages the utilization review process and patient progression from Admission to Discharge....collaboration with all members of the healthcare team, the UR /CCM is the principal liaison between emergency services, surgical… more
- University of Rochester (Rochester, NY)
- …Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500242 Neuropathology Work Shift: UR - Day (United States of America) Range: UR URCE 215 H ... and reporting of laboratory results, preventive maintenance procedures and records , and laboratory housekeeping. This position requires latitude for independence.… more
- University of Rochester (Rochester, NY)
- …Weekly Hours: 40 Department: 910137 CVSL - Vascular Surgery Work Shift: Range: UR URCB 213 Compensation Range: $69,326.00 - $90,124.00 _The referenced pay range ... and data management activity timeliness. Concurrently and retrospectively reviews medical records and data to identify patient care, process, and system issues… more