- 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 ... patient population and HackensackUMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- The Mount Sinai Health System (New York, NY)
- …Operating Room Surgical Scheduling, Mount Sinai West - Full Time, Days** The Utilization Review Specialist coordinates scheduling of all surgical/endoscopic ... **JOB DESCRIPTION** ** Utilization Review Admission Specialist ...and operating roaom time. 7. Checks credentials system for physician 's delineation of privileges for equipment and/or procedures according… 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
- Fairview Health Services (St. Paul, MN)
- …meets regulatory requirements. Participates in interdisciplinary communication related to utilization review issues. Educates on status. Provides all ... M Health Fairview has an immediate opening for a Utilization Management Specialist RN. This position provides...+ Current RN licensure in MN + 3-5 years utilization review or case management experience in… 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 will facilitate, coordinate, and approve… more
- The Mount Sinai Health System (New York, NY)
- …approved Identifies and refers to the UM Manager &/or Administrator and/or Physician problematic utilization and quality issues Responsible for the maintenance ... of services **RESPONSIBILITIES** Responsible for all aspects of the concurrent review program, insurance certification, and authorization process for all Psychiatric… more
- Hackensack Meridian Health (Neptune, NJ)
- …ED inpatient admissions and observations as specified by the facility's Utilization Management/ Review Committee for documentation completeness and compliance ... and serve as a leader of positive change. The Clinical Documentation Specialist facilitates improvement in the overall quality, completeness and accuracy of medical… more
- Huron Consulting Group (Chicago, IL)
- …as the expert you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring the appropriate ... to facilitate optimal patient outcomes while managing healthcare costs. The Utilization Management Specialist ensures compliance with regulatory requirements and… more
- AdventHealth (Altamonte Springs, FL)
- …The Senior Manager of Utilization will oversee ED, Inpatient, and Specialist utilization , and manage care management outcomes. The Senior Manager of ... . Develops and implements case management programs and education, including utilization review , transitions of care, disease management, population health… 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
- St. Luke's University Health Network (Allentown, PA)
- …registrations and/or physician queries + Serves as liaison between Physician Advisor/Medical Director, Finance, Utilization Review Department and ... patient's ability to pay for health care. The Surgical Review Specialist prospectively reviews, validates, and audits...lost with feedback to respective departments + Conduct concurrent review with utilization review department… 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
- HCA Healthcare (Overland Park, KS)
- …your knowledge and expertise! **JOB SUMMARY:** The Consulting Provider Solutions Specialist serves as a subject-matter expert for physician -facing technologies. ... growth, we encourage you to apply for our Consulting Provider Solutions Specialist opening. We promptly review all applications. Highly qualified candidates… more
- Sharp HealthCare (San Diego, CA)
- …be utilized for ongoing professional practice evaluation and re-credentialing.Collaborates with physician leadership to establish meaningful peer review criteria ... **What You Will Do** The purpose of the Sr. Performance Improvement Specialist is to improve clinical outcomes including responsibilities relating to leading teams… more
- Veterans Affairs, Veterans Health Administration (Spokane, WA)
- …of Geriatrics Rehabilitation Extended Care(GREC) Service, Mann Grandstaff VAMC. The CLC Staff Physician and Palliative Care Specialist will serve in three main ... Summary The Palliative Care Physician is assigned to the Community Living Center...the CLC for hospice/palliative care. Responsibilities This palliative care specialist will also contribute to and support the growth… 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
- HCA Healthcare (San Antonio, TX)
- …acute inpatient rehabilitation services prior to returning home. The Clinical Rehabilitation Specialist will review these patients daily until they have strong ... clinical evidence to request a physician order for a formal pre-admission assessment for acute...growth, we encourage you to apply for our Rehab Specialist opening. We promptly review all applications.… more
- Stanford Health Care (Palo Alto, CA)
- …one (1) year of experience as a licensed advanced practice provider: ( Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or Certified Registered ... Provides clinical direction and education, works closely with operational and physician leaders, and has oversight of hiring, termination, and professional growth… more
- Banner Health (Tucson, AZ)
- …are fortunate to work in an environment of partnership, with highly engaged Physician Medical Staff Leaders. We work to integrate our company's values of: customer ... process changes pertaining to regulatory and accreditation compliance, and resource utilization . CORE FUNCTIONS 1. Coordinates all aspects of medical staff… more
- Carle (Urbana, IL)
- …on each applicable transfer, completes documentation per hospital guidelines.* Performs admission Utilization review on all direct admissions & transfers to ... RN- Clinical Admission Specialist + Department: Transfer Coordination - CMH +...EMTALA guidelines). Actively collaborates with providers, nursing, and case management/ utilization management to ensure appropriate patient placement for optimal… more