- Trinity Health (Boise, ID)
- …Saint Alphonsus is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This position will be ... annually by the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is the lead provider for… more
- Billings Clinic (Billings, MT)
- …payer UM representatives on denials and coordinate peer to peer review with payer's medical director Initiates and coordinates peer to peer reviews on all ... or level of care. Obtains information not documented in the EMR and requests documentation of medical necessity to support appropriate status (IP, OP, OBS) and… more
- Albany Medical Center (Albany, NY)
- …actions to achieve continuous improvement in both areas.* Refers cases and issues to Medical Director and Triad Team in compliance with Department procedures and ... and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation ...Care Plans Thank you for your interest in Albany Medical Center! Albany Medical is an equal… more
- UTMB Health (Galveston, TX)
- …resource utilization to Director /Assistant Director of Utilization Management. + Maintains a documentation system of all review activities ... medical services, procedures, and facilities. Supports the UTMB Utilization Management Program utilizing clinical knowledge, expertise, and criteria guidelines.… more
- Guthrie (Binghamton, NY)
- …as necessary with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as appropriate. a) Serves ... coding, medical record or chart auditing, and experience in utilization management processes preferred. Knowledge of computer applications (such as Microsoft… more
- Albany Medical Center (Albany, NY)
- …actions to achieve continuous improvement in both areas.* Refers cases and issues to Medical Director and Triad Team in compliance with Department procedures and ... and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation ...care team Thank you for your interest in Albany Medical Center! Albany Medical is an equal… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …and communicate potential or identified concerns to the treatment team, Director of Utilization Management, and the Medical Director . + Review charts at ... healthcare and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of behavioral health… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day operations of… more
- Huron Consulting Group (Chicago, IL)
- …internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and ... the expert you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring the appropriate utilization … more
- Independent Health (Buffalo, NY)
- …to determine medical necessity, and if necessary, will consult with the Associate Medical Director for all requests that do not meet criteria or IHA policy. ... and Accountable. **Essential Accountabilities** + Provide high quality, professional utilization management services: ( medical necessity review for Prior… more
- Martin's Point Health Care (Portland, ME)
- …prior authorization requests (prior authorization, concurrent review, and retrospective review) for medical necessity referring to Medical Director as needed ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a...for ensuring the receipt of high quality, cost efficient medical outcomes for those enrollees with a need for… more
- HCA Healthcare (Campbell, CA)
- …present authorization requests with supporting documentation for review with the Medical Director . Assume responsibility for ensuring timely reviews of ... and integrity. We care like family! Jump-start your career as a(an) Utilization Management RN today with HCA Healthcare. **Benefits** HCA Healthcare, offers a… more
- Hartford HealthCare (Torrington, CT)
- …Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the IP Psychiatry Patient ... Care Team to assure Utilization Review activities on a 17 bed Adult unit....promote the individualized care plan. * Maintains timely patient-centered documentation that reflect the patient and client systems' pertinent… more
- Acacia Network (Bronx, NY)
- …care plan (interdisciplinary) team, identifying and referring requests for services to the Medical Director when guidelines are not met and reviewing residential ... Acacia Network Inc. Utilization Manager Bronx, : 5/30/2024 Job Description Job...from third party payers at pre-admission through discharge, ongoing medical necessity reviews and interdisciplinary team support with respect… more
- The Cigna Group (Bloomfield, CT)
- …well as research and provide a written detailed clinical summary for the Plan Medical Director . + Determine whether additional pre service, appeal or grievance ... appeals will include requests for decisions regarding denials of medical services as well as Part B drugs. The...of appeal by interpreting Medicare and Medicaid regulations; reviewing documentation to ensure that all aspects of the appeal… more
- Katmai (Usaf Academy, CO)
- …+ Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise. + Review clinical ... for assuring the receipt of high quality, cost efficient medical outcomes for those enrollees identified as having the...Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,… more
- BronxCare Health System (Bronx, NY)
- …Patient and Customer Service. - Reviews and denials notification letters along with the medical records and all pertinent documentation related to the episode of ... order to prepare a response for submission in appeal. - In absence of Director , will review denial correspondence to determine validity of denial reason and course… more
- Magellan Health Services (Honolulu, HI)
- …and implementing medical action plans. + Supports senior medical director in parity analyses and documentation . + Participates in committee work and ... quality improvement activity (QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May participate in various… more
- Humana (Columbus, OH)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director actively uses their medical...insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management… more
- Houston Methodist (Houston, TX)
- …most clinically appropriate care to patients while promoting the most cost-effective utilization of the hospital's resources. The Director Case Mgmt Social ... At Houston Methodist, the Director Case Mgmt Social Svcs position is responsible...improvements as needed. + Drives and establishes relationships with medical staff, promotes teamwork while ensuring patient care issues… more