- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …the Medical Director when appropriate, according to policy\. + Assists non\- clinical staff in performance of administrative reviews + Performing comprehensive ... provider and member appeals, denial interpretation for letters, retrospective claim review , special review requests, and UM pre\-certifications and appeals,… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... medical records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to… more
- Trinity Health (Silver Spring, MD)
- …the activities of RN Case Managers for in inpatient care coordination and utilization review . Oversees interactions of staff with outside activities and agencies ... an acute healthcare setting required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At least 5-7… more
- Hartford HealthCare (Torrington, CT)
- …**Job:** **Professional Clinical * **Organization:** **Charlotte Hungerford Hospital* **Title:** * Utilization Review Social Work Care Manager (LCSW) ... of the Inpatient Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the IP… more
- Hackensack Meridian Health (Hackensack, NJ)
- …patient population and HackensackUMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, ... **Overview** The Senior Utilization Review Specialist collaborates with the...direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight… more
- Billings Clinic (Billings, MT)
- …/ Management RN. This position is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization . Coordinates with ... prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings Clinic (Billings Clinic… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of care and promoting ... with questionable medical necessity to Physician Advisor for determination. + Review clinical and diagnostic interventions for appropriateness and timeliness… more
- Trinity Health (Mason City, IA)
- …**Hours:** Monday-Friday 0630-1430; no weekends or holidays **About The Job** The Utilization Review Case Manager responsibilities include case screening, ... resource management, knowledge of community resources, and collaboration with other clinical disciplines. **What We Are Looking For** Education [formal]: + Licensed… more
- Elevance Health (Tampa, FL)
- …requirements:** + Requires a HS diploma or equivalent and a minimum of 2 years of clinical or utilization review experience and minimum of 1 year of managed ... **Licensed Utilization Review II** **Location** : KS,...appropriate and consistent administration of plan benefits through collecting clinical information required to preauthorize services, assess medical necessity,… more
- Trinity Health (Columbus, OH)
- **Employment Type:** Part time **Shift:** Day Shift **Description:** ** Utilization Review RN, Casual / PRN** Position Purpose: RN Utilization Review Case ... as a Registered Nurse (RN) in Ohio. * 3+ years of relevant clinical work experience. Ministry/Facility Information: Mount Carmel, a member of Trinity Health, has… more
- Prime Healthcare (Lynwood, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/171837/*case- manager %2c-rn utilization - review ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager … more
- UNC Health Care (Hillsborough, NC)
- **Description** RN Utilization Manager is responsible for clinical reviews for medical necessity for both admission and continuing stay patients during the ... through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …requested clinical and psychosocial information to assure reimbursement. UTILIZATION REVIEW + Reviews prospectively, concurrently and retrospectively all ... responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient… more
- BayCare Health System (Cotton Plant, AR)
- …and more Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review Specialist Senior **Location** Clearwater:Morton Plant | Clinical | ... and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and compassionate… more
- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager ** Location: Dublin, OH Primary Job Function: Medical Management ID**: 37872 Your career starts now. We are ... reporting/analytics for UM OH, and serves as SME for clinical components of the OH Medicaid Utilization ...review , continuity of care, care coordination, and other clinical and medical management programs. + Have working knowledge… more
- ERP International (Corpus Christi, TX)
- **Overview** ERP International is seeking a **Registered Nurse (RN)** ** Utilization Manager ** for a full-time position in support of the **Naval Health Clinic ... range of utilization management services including referrals, care coordination, utilization review , discharge planning, continued stay reviews, and appeal… more
- Trinity Health (Maywood, IL)
- …at the Westmont office Join our small but mighty team to guide and manage Utilization Review and Management for the Loyola Physician Partners LPP) Health Plan, a ... Manager oversees the daily caseloads of the UR/UM teams. This includes utilization review of inpatient medical and behavioral health services to assess… more
- AdventHealth (Altamonte Springs, FL)
- …. Develops and implements case management programs and education, including utilization review , transitions of care, disease management, population health ... **Senior Manager of Utilization ** **-AdventHealth Well65** **All.... 2 years of experience in a physician's office, clinical or hospital setting. . Knowledge of chronic diseases,… more
- Prime Healthcare (Lynwood, CA)
- …licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/174454/*case- manager -rn-%2c- utilization - review ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager … more
- Huron Consulting Group (Chicago, IL)
- …on established criteria and guidelines. + Maintain accurate and detailed records of review decisions and interactions in the utilization management system. + ... Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new… more