- Novo Nordisk Inc. (Irvine, CA)
- …and unique insights Leverages superior understanding of complexities within the targeted physician customer base in order to maximize performance Applies high level ... appropriate patients that would benefit in order to ensure early trial and utilization Generates advocacy for Novo Nordisk products and services by sharing approved… more
- 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
- Munson Healthcare (Traverse City, MI)
- …families, interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic ... State of Michigan. + Minimum of three years clinical experience required. Previous utilization review and/or case management in a hospital or insurance industry… more
- Community Health Systems (Franklin, TN)
- …additional documentation from the physician (s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if physicians are ... of medical services and procedures in the hospital setting. Utilization review is the assessment for medical...have an ED Case Manager present, the UR Clinical Specialist will collaborate with Emergency Room Physician /staff… more
- Lawrence General Hospital (Lawrence, MA)
- The Utilization Review Specialist , under...with the Utilization Review Coordinator, Utilization Review Nurses, Physician advisor ... well as the integrated care team and supports the case management/ utilization review team on system-wide quality improvement/performance improvement initiatives.… more
- Sutter Health (Berkeley, CA)
- …and others to ensure appropriate utilization and quality care through utilization review , tracking and evaluation and objectively compare criteria with ... clinical nursing staff and other departments regarding documentation required for utilization review activities and processes. Collaborate with medical, nursing… more
- Trinity Health (Maywood, IL)
- …is Loyola campus. Position is hybrid, must reside in Illinois. The **Regional Utilization Review Documentation Specialist ** nurse works with the ... **Employment Type:** Full time **Shift:** Day Shift **Description:** Utilization Review - RN Reviewer- Regional Coverage for Loyola, Gottlieb and MacNeal… 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
- 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
- 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
- Community Health and Counseling Services (Bangor, ME)
- Insurance Verification and Utilization Review Specialist - Health Services Job Type(s):Full-Time Location(s):Bangor, Maine Education:Associates Degree - ... collaborating with Agency staff, patients, family members, facilities and physician . Responsible for utilization management of services, verifying… 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
- 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
- WMCHealth (Valhalla, NY)
- …and coding principles and guidelines; good knowledge of healthcare delivery system, utilization review , case review and quality improvement practice ... Network CDI Physician Champion Company: NorthEast Provider Solutions Inc. City/State:...processes. The Physican Champion will provide clinically based concurrent review of patient medical records to ensure documentation accurately… 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
- 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 ... serve as a leader of positive change. The **Clinical Documentation Specialist Registered Nurse (RN)** facilitates improvement in the overall quality, completeness… 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
- 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
