- ProMedica Health System (Toledo, OH)
- The Payor Specialist is responsible for payor notification, and securing authorizations for all admissions systemwide. They receive and answer voicemail and ... of all inpatient and observation admissions systemwide with per payor contract via phone, fax, and payer portals to...various WQs assigned in Epic. Submits clinical information per payor contract via payer portals, fax or Secure Outlook… more
- LifePoint Health (Athens, TN)
- …seeking talent to fill the position of Intake Nurse and Utilization Specialist for ourGeroPsychDepartment.This job is permanent,full-time. Core competencies ... **Starr Regional Medical Center* **Title:** * Intake Nurse and Utilization Specialist * **Location:** *Tennessee-Athens* **Requisition ID:** *7412-6736* more
- Trinity Health (Pontiac, MI)
- …RN licensure within the State of Michigan. Certified Professional in Utilization Review /Management preferred. **C** **Special Skill / Aptitudes** Understanding ... care utilization management experience. Knowledge of regulations relative to utilization review . Knowledge of Federal, State and Local regulations sources.… more
- Select Medical (Frisco, TX)
- …licenses, if candidate also has extensive experience with prior authorizations and/or utilization review + Previous Experience within a physical rehabilitation ... **Responsibilities** **Job Responsibilities** Using discretion and independent judgment, the Payor Relations Specialist manages the pre-certification and prior… more
- Houston Methodist (Houston, TX)
- …caring for adults in an acute care hospital setting is required; coding and utilization review experience preferred + For Medical School graduate - One year ... At Houston Methodist, the Clinical Documentation Specialist is responsible for improving the overall quality and completeness of clinical documentation. This… more
- BrightSpring Health Services (Louisville, KY)
- …nursing from an accredited or approved school + Two years of experience in health care utilization review or home health care + Clinical review will require ... Our Company BrightSpring Health Services Overview The Clinical Coding and Audit Specialist monitors, responds and performs the clinical coding and audit support… more
- Baylor Scott & White Health (Dallas, TX)
- …+ Calculates accurate patient financial responsibility. + Communicates timely with Utilization Review , and collaborates effectively with physician and facility ... **JOB SUMMARY** The Insurance Verification Specialist 1, under general supervision, provides patients, physicians and internal hospital personnel with insurance… more
- RWJBarnabas Health (Elizabeth, NJ)
- Specialist , OP Adult PartialReq #:0000161130 Category:Clerical / Administrative Support Status:Full-Time Shift:Day Facility:Trinitas Regional Medical Center ... entry on all managed care/EAP cases including information on payor status forms and timely entry into a computer...and physicians to obtain clinical data for continuing case review s; facilitate time completion and submission of forms… more
- Guthrie (Binghamton, NY)
- …acute clinical experience in a hospital setting required. Critical care, utilization review or coding experience required. Requires excellent communication ... 2. Demonstrates knowledge of CDMP guidelines and program, DRG payor issues, documentation opportunities, clinical documentation requirements, and referral policies… more
- Mohawk Valley Health System (Utica, NY)
- … regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... and reimbursement models in decision making and reviews. + Provide peer-to-peer payor review in collaboration with attending physicians. + Support Recovery… more
- AdventHealth (La Grange, IL)
- …to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient...days, and facilitates progression of care. **.** Collaborates with Utilization Management staff for collaboration on patient status changes… more
- AdventHealth (Winter Garden, FL)
- …to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning, and care ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient...days, and facilitates progression of care. + Collaborates with Utilization Management staff for collaboration on patient status changes… more
- AdventHealth (La Grange, IL)
- …to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient...days, and facilitates progression of care. **.** Collaborates with Utilization Management staff for collaboration on patient status changes… more
- Columbus Regional Hospital (Columbus, IN)
- …years of strong clinical experience in a clinical practice area + Knowledge of utilization review and InterQual (CRH provides training & time to acquire ... discharge - an integrated team of a Patient Resource Specialist , a Social Work Specialist and a...+ The Clinical Care Coordinator role integrates and coordinates utilization management, care facilitation and discharge planning function in… more
- Columbus Regional Hospital (Columbus, IN)
- …years of strong clinical experience in a clinical practice area + Knowledge of utilization review and InterQual (CRH provides training & time to acquire ... discharge - an integrated team of a Patient Resource Specialist , a Social Work Specialist and a...+ The Clinical Care Coordinator role integrates and coordinates utilization management, care facilitation and discharge planning function in… more
- St. Luke's University Health Network (Allentown, PA)
- …after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications. The appeals process may include collaboration ... is a Certified Medical Coder who ensures clean claim submission and timely review and resolution of coding related claim denials for professional services, FQHC,… more
- Carle (Urbana, IL)
- …coding. HIM coder uses Carle electronic medical record systems to review clinical encounters. Qualifications: EDUCATIONAL REQUIREMENTS None Required CERTIFICATION & ... hire or Registered Health Information Tech (AHIMA) upon hire or Certified Coding Specialist (AHIMA) upon hire or Certified Coding Specialist Physician Based upon… more
- AdventHealth (Orlando, FL)
- …patient and involved care givers (as permitted by the patient) as well as a review of the current and past inpatient and outpatient medical record in the Initial ... primary care physician identification and scheduling of follow-up PCP and specialist appointments for post[1]hospital follow up care. + Maintains clinical competency… more