- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Bakersfield Behavioral Healthcare Hospital (Bakersfield, CA)
- …leadership, teamwork, and communication skills. ESSENTIAL DUTIES The primary responsibility of the Utilization Review Specialist is to review medical ... of candidates. Education Associates Degree preferred Minimum Work Experience Utilization Review experience preferably in a behavioral/psychiatric healthcare… more
- HonorHealth (Scottsdale, AZ)
- …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Medical Center Hospital (Odessa, TX)
- Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician Advisors. Education: Holds a current Texas license as a… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Tufts Medicine (Burlington, MA)
- …and smooth flow of communication and administrative support activities for the Utilization and Case Management departments. This position is well versed in insurance ... hire. 4. Three (3) years hospital/health care experience in the area of Utilization Management. 5. Basic Life Support Certification **OR** Obtain within three (3)… more
- Community Health Systems (Franklin, TN)
- …maintaining awareness of payer scheduling practices and deadlines. + Works closely with Physician Advisors, Utilization Review , and Denial Management teams, ... **Job Summary** The Physician Advisor Specialist is responsible for...payers, auditors, and internal teams. This role collaborates with Utilization Review (UR), Shared Service Center (SSC),… more
- MD Anderson Cancer Center (Houston, TX)
- …Serves as an expert resource and support to onsite review nurses and Utilization Review Specialist Completes level of care (LOC) assessments on all ... employees and the public. The primary purpose of the Utilization Review Nurse position is to: Evaluate...criteria and concerns in a timely manner with the physician and interdisciplinary team to resolve issues/concerns with payors… more
- Intermountain Health (Las Vegas, NV)
- …care organizations, which includes Medicare coverage criteria. **Job Profile:** Performs medical review activities pertaining to utilization review , claims ... with MG clinicians, Affiliate Network PCPs and Specialists in the community, utilization management, care management, claims, network management, and finance. As the… more
- Baystate Health (Springfield, MA)
- …Psychiatric Advanced Practice Nurse, Physician Assistant, Occupational Therapist, Utilization Review Specialist , Mental Health Counselor, Patient ... psychoeducational groups as assigned. **6)** May collaborate as assigned with utilization review specialist to obtain necessary insurance authorizations and… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Senior (Sr.) Communications Specialist position is responsible for developing proactive hospital and executive communications, leading ... effectively cultivating and nurturing media relationships. The Senior Communications Specialist will develop communications strategies to ensure stakeholders achieve… more
- Sanford Health (SD)
- …also acceptable, ie Certified Coding Specialist (CCS), Certified Coding Specialist - Physician based (CCS-P), Certified Professional Coder (CPC), Certified ... Details** Opportunity to work remote. **Job Summary** Monitors the utilization of resources, risk management and quality of care...is not exceeded without due notice to the attending physician . May also need to notify physician … 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, ... billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of...and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …with Utilization Management and Clinical Appeals Departments to regularly review data from same specialty and independent review organizations. Utilize ... our Healthsource blog: https://healthsource.premera.com/ . The **Medical Policy (MP) Clinical Specialist ** is a critical role in Premera, responsible for the… more
- CaroMont Health (Gastonia, NC)
- …factual arguments to recoup revenue. This position also facilitates collaboration between the Utilization Review Specialist 's, Coding staff, HIM staff, CDI ... and Denial Specialist will work collaboratively with Health Information Management, Utilization Review and Clinical Documentation Specialist to mitigate… more
- Veterans Affairs, Veterans Health Administration (Indianapolis, IN)
- …audits Works with Chief of Medicine and Medicine Service Health Systems Specialist to monitor clinic workspace utilization and identify additional space ... team huddles as assigned by the Service Chief. Meets regularly with VA Utilization Management staff to understand and review relevant Medicine Service… more
- Veterans Affairs, Veterans Health Administration (Fayetteville, NC)
- …improvement certification Current mastery level certifications include: Certified Coding Specialist (CCS), Certified Coding Specialist - Physician -based ... medical data from patient health records in the hospital setting, and/or physician -based settings, such as physician offices, group practices, multi-specialty… more
- HCA Healthcare (Dallas, TX)
- …staff performance evaluations. + Acts as manager in charge as assigned. + Provides review and guidance on physician order sets and other evidenced based ... in daily multidisciplinary and bedside rounds + Completes drug utilization reviews to promote rational drug therapy and implement...we encourage you to apply for our Clinical Pharmacist Specialist BMT PRN opening. We promptly review … more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Enhanced Care Management Clinical Specialist II Job Category: Clinical Department: Care Management...Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM),… more
- Trinity Health (South Bend, IN)
- …(pre-certifications, third party payer authorizations, referrals) and will contact the physician /office and Case Management/ Utilization Review colleagues as ... entered on the wrong encounter. Validates complete and accurate documentation by Physician / Utilization Management colleague is met prior to completing Bed… more