- Integra Partners (Troy, MI)
- …and representing Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director's responsibilities ... require. The Senior MD provides clinical oversight to the Utilization Review Medical Director(s), ensures consistent application of criteria, leads … more
- Ventura County (Ventura, CA)
- …the general and specialized principles, practices, techniques and methods of utilization review /management, discharge planning or case management. + utilize ... Senior Registered Nurse - Hospital Management Utilization...nursing processes in designated hospital units of Ventura County Medical Center and Santa Paula Hospital. The Senior… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Senior Business Analyst - Utilization Management Location: Hybrid | Eagan, ... business solutions through research, audit, and analysis of data for Utilization Management. Your Responsibilities * Participates in process change and redesign… more
- CaroMont Health (Gastonia, NC)
- …MCO, Medicare, or RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of ... medical necessity will be performed and documented in medical review , including daily status update while...NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC - Clear Lake Center **Webster, Texas, United States** Nursing & Care Management UTMB Health Requisition # 2506588 The mission ... or observation in Community Hospitals and UTMB-TDCJ Hospital. + Performs utilization review procedures by prospectively, concurrently, and retrospectively… more
- BayCare Health System (Tampa, FL)
- …a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior /RN responsibilities include:** + ... to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- Hackensack Meridian Health (Hackensack, NJ)
- **The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- CommonSpirit Health (Phoenix, AZ)
- … medical necessity of healthcare services, treatments, and procedures. Lead medical review activities, ensuring compliance with regulatory and accreditation ... + Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. + Physician Advisor Sub-specialty… more
- LifeCenter Northwest (Bellevue, WA)
- …Salary Position Type Full Time Description and Qualifications The Director, Organ Utilization (Director), is responsible for overseeing the processes and teams that ... and executes strategies to improve organ allocation strategy and organ utilization , collaborates closely with transplant programs and the surgical recovery team… more
- Centene Corporation (Sacramento, CA)
- …industry best practices related to utilization management + Works with utilization management team and senior management to identify opportunities for ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Prime Healthcare (Chino, CA)
- …Center is nationally recognized, locally preferred, and community focused. Responsibilities The Utilization review tech essentially works to coordinate the ... utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls,… more
- Ascension Health (Austin, TX)
- … review programs and key performance indicators for all utilization review activities. + Interact with medical , nursing, and executive leadership to ... salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… more
- CenterWell (Austin, TX)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- CenterWell (San Juan, PR)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- Zurich NA (Schaumburg, IL)
- Medical Bill Review Senior Nurse...2 or more years' experience in Utilization Review , Case Management, Workers Compensation, or medical bill ... 127127 Zurich Insurance is currently looking for a ** Medical Bill Review Senior Nurse** to work from our Schaumburg, IL office. With limited direction,… more
- Ventura County (Ventura, CA)
- …more efficient, and patient-centered care. Under general direction, the Senior Medical Management Nurse is responsible for performing utilization review , ... Senior Medical Management Nurse - VCHCP...but are not limited to the following: + Performs utilization review with pre-certification, concurrent, retrospective, out… more
- Centene Corporation (Jefferson City, MO)
- …are seeking candidates with strong experience in payment integrity and utilization review .** **Education/Experience:** Requires Graduate from an Accredited ... services to identify quality of care issues and, if identified, refer to the Medical Director for review and verification + Applies clinical knowledge to ensure… more
- Centene Corporation (Jefferson City, MO)
- …management, cost containment, and medical quality improvement activities. + Perform medical review activities pertaining to utilization review , ... with respect to clinical issues and policies. + Identify utilization review studies and evaluates adverse trends... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- Houston Methodist (Sugar Land, TX)
- … Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Houston Methodist (Houston, TX)
- …those projects to bigger picture system ideas.** At Houston Methodist, the Senior Manager Operations position is responsible for the strategic and ongoing ... initiative, effective interpersonal skills and oral/written communication skills. The Senior Manager Operations position is responsible for the efficient and… more