- 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 ... Relations Manager to facilitate coordination of services related to utilization review . Collaborates with the multidisciplinary team, lending professional… more
- Community Health Systems (Franklin, TN)
- …appropriate additional documentation from the physician(s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if physicians ... of medical services and procedures in the hospital setting. Utilization review is the assessment for medical...event a facility does not have an ED Case Manager present, the UR Clinical Specialist will collaborate with… more
- VNS Health (Manhattan, NY)
- …CEU credits, and advancement opportunities What You Will Do + Reviews specific utilization issues or requests with Clinical Review team, focusing on problem ... + Manages and evaluates staff in delivery and coordination of utilization management review services in compliance with CMS guidelines and consistent with… more
- Henry Ford Health System (Troy, MI)
- …and operational processes to ensure optimal and compliant utilization review strategies. Under minimal supervision from the Manager the Supervisor ... GENERAL SUMMARY: The Supervisor of Utilization Management has an important role in a...Additional Information + Organization: Corporate Services + Department: Central Utilization Mgt + Shift: Day Job + Union Code:… more
- VNS Health (Manhattan, NY)
- …cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in ... subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is… more
- Providence (Mission Hills, CA)
- …Schedule:** Part time **Job Shift:** Day **Career Track:** Nursing **Department:** 7000 UTILIZATION MGMT REMOTE **Address:** CA Mission Hills 15031 Rinaldi St ... **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records… more
- BayCare Health System (Clearwater, FL)
- …foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions ... start for up to 6 months, then eligible for remote ) + **On Call:** No **Certifications and Licensures:** +...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- Fairview Health Services (St. Paul, MN)
- …Work on a variety of special projects and assume other duties as assigned by the Utilization Review Manager or Supervisor. + Understand and focus on key ... join our Revenue Cycle Management team. This is a remote position.** This position, under Revenue Cycle Management, is...**Required** + Bachelor's degree in Nursing + 3-5 years Utilization Review or Case Management experience in… more
- Texas Health Resources (Arlington, TX)
- **RN/Registered Nurse- Utilization Management, Clinical Reviews** **Work location:** 100% remote but must live in Texas, preferably in the Dallas-Fort Worth ... members of the health care team. + Determine working DRG with each initial review via CareConnect1 or other Utilization Management tool. Discusses working DRG… more
- Elevance Health (NY)
- **Clerk - Utilization Management Representative I** **Location:** Elevance Health supports a hybrid workplace model (virtual and in-office) with PulsePoint sites ... used for collaboration, community, and connection. This includes remote work and 2 days in-office per week at...week at our Staten Island location. The **Clerk - Utilization Management Representative** is responsible for coordinating cases for… more
- Elevance Health (Latham, NY)
- Job Description **Title: Utilization Management Representative I** **Location:** This position will work a hybrid model ( remote and office). Ideal candidates ... live within 50 miles of one of our PulsePoint locations. The ** Utilization Management Representative I** will be responsible for coordinating cases for… more
- Elevance Health (Louisville, KY)
- **Title: Utilization Management Representative II** **Location:** This position will work a hybrid model ( remote and office). Ideal candidates will live within ... 50 miles of one of our PulsePoint locations. The ** Utilization Management Representative II** will be responsible for managing...provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for… more
- Elevance Health (Norfolk, VA)
- **Title: Utilization Management Representative I** **Location:** This position will work a hybrid model ( remote and office). Ideal candidates will live within 50 ... miles of one of our PulsePoint locations. The ** Utilization Management Representative I** will be responsible for coordinating cases for precertification and prior… more
- US Tech Solutions (Columbia, SC)
- **Job Description:** + Remote once training is complete. M-F 8:30am - 5pm. No 10hr schedules available at this time. + From the Manager : -Experience: Hospital ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- University of Miami (Miami, FL)
- …an exciting opportunity for a full time Utilization Review Case Manager to work to work remote . The incumbent conducts initial, concurrent and ... retrospective chart reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the healthcare team for… more
- VNS Health (Manhattan, NY)
- …cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in ... subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is… more
- Target (Minneapolis, MN)
- …for every touchpoint. **About the** **role** **: ** As a Lead UX Operations Manager supporting our Enterprise UX team you'll be at the forefront of Target's evolving ... clear processes for design delivery, defining who needs to review work and when + Lead the development and...Build and maintain systems for tracking individual and team utilization ,identifying gaps, and supporting hiring plans + Establish and… more
- KeyBank (Boston, MA)
- …Driven Repayment (IDR). Every client is offered a free 30-minute consultation to review their unique student loan situation and available options. Paid PSLF and IDR ... memberships, including an annual review , are available if clients prefer to have GradFin...financial advisors, corporate and hospital partnerships. The GradFin Sales Manager reports to the Head of GradFin, and is… more
- CVS Health (Tallahassee, FL)
- …reimbursement policy **Preferred Qualifications** + Crisis intervention skills + Managed care/ utilization review experience + Case management and discharge ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Assessment of… more
- Highmark Health (Columbus, OH)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management, and… more