- R1 RCM (Pittsburgh, PA)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. **Title: Utilization Review Nurse ** **Location: Hospital Client ... 11a-7p EST. Hours may vary and some flexibility may be offered** As our ** Utilization Review Nurse ** , you will help our hospital clients by working… more
- UPMC (Pittsburgh, PA)
- UPMC Your Care is hiring Nurse (RN) Clinical Care Coordinator. Your territory will be in the East Suburbs, Plum, Monroeville areas. You will be working Monday - ... Gardens, 1650 Metropolitan Street, 15233. Eastern Suburbs, Plum, Monroeville etcThe Nurse Clinical Care Coordinator is responsible for delivery of nursing assessment… more
- UPMC (Pittsburgh, PA)
- …criteria (InterQual). + Ability to apply InterQual criteria appropriately. + Prior utilization review experience. + Knowledge of payer reimbursement structure. + ... career? UPMC is looking to hire a full-time Authorization Nurse . This position works Monday through Friday, as well...level of care and/or medical appropriateness. + Ensure clinical review process is followed in order to meet payor… more
- Fresenius Medical Center (Baden, PA)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- UPMC (West Mifflin, PA)
- …promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member, ... and other health plan and system departments as appropriate. + Review member's current medication profile; identify issues related to medication adherence,… more
- Highmark Health (Jefferson Hills, PA)
- …including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and ... outcomes, engages patients/caregivers in their healthcare, and supports effective resource utilization . Serves as key team members in the management of readmissions,… more
- UPMC (Pittsburgh, PA)
- …the clinical and financial plan for patients. Performs overall utilization management, resource management, discharge planning and post-acute care referrals ... all Avoidable Days in CANOPY system. + Performs clinical review on admission and/or continued stay using InterQual criteria...and Clearances:** + Current licensure as a Registered Professional Nurse either in the state where the facility is… more