- 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
- BayCare Health System (St. Petersburg, FL)
- …a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + ... + Community discounts and more Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review Specialist Senior **Location** St Petersburg… more
- Amity Foundation (Tucson, AZ)
- …community building. Remembrance, Resolution, Reconciliation, Restoration, Renewal Job Summary: As the Utilization Review Specialist , you will contribute to ... the organization by providing vital support to the community by developing and/or maintaining effective...pressure generated by association with substance abuse students. Title: Utilization Review Specialist Reports To:… more
- System One (Baltimore, MD)
- …and benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist , will analyze clinical information, ... ALTA IT Services is staffing a contract to hire opportunity for a Utilization Management Specialist to support a leading health insurance customer. The… 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 Registered Nurse. Training and Experience: Three years clinical nursing experience in general… more
- Reno Behavioral Healthcare Hospital (Reno, NV)
- The UR Specialist reviews and monitors patients' utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties ... Officer/Medical Director as appropriate. + Coordinates an interdisciplinary approach to support continuity of care. + Provides utilization management, transfer… more
- Truman Medical Centers (Kansas City, MO)
- …into myWORKDAY (http://www.myworkday.com/trumed/d/home.htmld) to search for positions and apply.** Utilization Specialist 101 Truman Medical Center **Job ... training, coaching and consulting to outside organizations. **Job Description** The Utilization Specialist will verify all financial and insurance information,… more
- Sanford Health (SD)
- …Hours:** 40.00 **Salary Range:** $26.00 - $41.50 **Job Summary** Provides clinical support to the MCHS revenue cycle for denial management and clinical workflows ... hospital experience preferred. Preference given to individuals with experience in utilization or with CPT/ICD knowledge. Currently holds an unencumbered Licensed… 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: ... County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose....net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,… more
- Vanderbilt University Medical Center (Nashville, TN)
- …moderate difficulty. * Clinical Applications Systems (Novice): Possesses fundamental proficiency in utilization review systems, clinical support systems and ... business support applications as needed * Utilization Review (Intermediate): Demonstrates expertise of utilization review in practical applications… more
- Sanford Health (Sioux Falls, SD)
- …level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to assure ... relating to determination of medical necessity, authorization, continued stay review including diagnosis and procedural coding for working diagnosis related… more
- Tufts Medicine (Burlington, MA)
- …Ensures continuous, efficient and smooth flow of communication and administrative support activities for the Utilization and Case Management departments. ... of hire. 4. Three (3) years hospital/health care experience in the area of Utilization Management. 5. Basic Life Support Certification **OR** Obtain within three… more
- MD Anderson Cancer Center (Houston, TX)
- …as an expert resource and support to onsite review nurses and Utilization Review Specialist Completes level of care (LOC) assessments on all assigned ... employees and the public. The primary purpose of the Utilization Review Nurse position is to: Evaluate...to support medical necessity for services Ensures utilization review case closures are completed within… 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
- Intermountain Health (Murray, UT)
- …regulatory requirements. + Occasional travel to provider locations within Select Health region. ** Utilization Review and Care Management:** + ** Review and ... expertise of a Licensed and Masters Prepared Behavior Health Specialist with Utilization and Care management. This...in behavioral health. + Knowledge of healthcare insurance and utilization review processes. + Excellent communication and… more
- BayCare Health System (Clearwater, FL)
- …a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + ... services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- Katmai (Usaf Academy, CO)
- …for inpatient/outpatient precertification. **ESSENTIAL DUTIES &** **RESPONSIBILITIES** + Review precertification requests for medical necessity, referring to the ... Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part of the UMRN program, conduct ongoing… more
- MyFlorida (Tallahassee, FL)
- OPERATIONS REVIEW SPECIALIST - 60020714 - ESS Date: Mar 13, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... No: 848234 Agency: Children and Families Working Title: OPERATIONS REVIEW SPECIALIST - 60020714 - ESS Pay...on short notice to perform duties and travel in support of disaster relief. During such events, incumbent may… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …a line of business. The MP Clinical Specialist works closely with non-clinical support staff and the clinical review department to identify and resolve any ... Utilization Management and Clinical Appeals Departments to regularly review data from same specialty and independent review...requested. + Develop and present clinical education materials for review staff (doctors and nurses) to support … more
- The City of Rochester, MN (Rochester, MN)
- Marketing & Energy Services Support Specialist Print (https://www.governmentjobs.com/careers/rochester/jobs/newprint/4868413) Apply Marketing & Energy Services ... Support Specialist Salary $29.40 - $36.93 Hourly...receiving in applications via mail, electronically, or in-person, application review and verification against the customer care system, verifying… more