- UCLA Health (Los Angeles, CA)
- Description As the Utilization Management & Quality Review Specialist, you will be responsible for: + Managing service requests and potential quality ... to all stakeholders. + Working closely with medical director, utilization management and quality review team to ensure that all cases are handled… more
- UCLA Health (Los Angeles, CA)
- Description As the Utilization Management & Quality Review Nurse, you will be responsible for: + Ensuring appropriate, cost-effective, and high- ... quality care for New Century Health Plan members + Conducting utilization management (UM) activities in accordance with health plan policies and regulatory… more
- CaroMont Health (Gastonia, NC)
- …in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management , Quality and/or Case Management preferred. ... to MCO via fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments,… more
- Covenant Health Inc. (Louisville, TN)
- Overview Utilization Review Coordinator, Quality Management Full Time, 80 Hours Per Pay Period, Day Shift Peninsula Overview: Peninsula, a division of ... budgeted targets. + Provides medical/psychiatric leadership/consultation to Provider Relations, Medical Utilization Management , and Quality Management … more
- Kepro (AR)
- … of clinical records. Preferred Qualifications/Experience: + Utilization Review / Utilization Management experience. + Clinical quality review ... + 2+ years of experience in a behavioral health setting, conducting behavioral health utilization reviews or behavioral health case management . + Ability to work… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review , under the supervision and in ... advisor and external review organizations to ensure quality outcomes, patient throughput, and appropriate resource utilization...in an acute healthcare setting required, preferably with case management , utilization review or closely… more
- Prime Healthcare (Ontario, CA)
- …is actively seeking new members to join our corporate team! Responsibilities VP Utilization Review and Clinical Denials Management will provide strategic ... leadership, direction and operational management for the Utilization Review and Clinical Denial Management teams. This position encompasses process… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …needed. + Interfaces with the provider community regarding medical care management , utilization review and quality improvement issues and concerns. + ... managed care. + Experience in the development and management of utilization review and quality improvement programs. + Outstanding oral and written… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- …a state agency this class is accountable for coordinating a utilization review program which promotes effective cost recovery, quality of care and/or ... Utilization Review Nurse Coordinator (40 Hour)...+ Coordinates workflow and determines priorities to assure highest quality of care with efficient utilization of… more
- Sutter Health (Berkeley, CA)
- …managers, clinical nursing staff and others to ensure appropriate utilization and quality care through utilization review , tracking and evaluation and ... systems for the appeal/denial process, tracks and trends data, and coordinates utilization management activities for the assigned area. Collaborates with… more
- Behavioral Center of Michigan (Warren, MI)
- Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex ... clinical data and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart and records clinical… more
- Stanford Health Care (Palo Alto, CA)
- …Skills and Abilities** + Knowledge of principles and best practices of case management , utilization review , social work, care coordination and discharge ... practice. Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation,… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Munson Healthcare (Traverse City, MI)
- …the State of Michigan. + Minimum of three years clinical experience required. Previous utilization review and/or case management in a hospital or insurance ... assessment and critical thinking skills necessary to provide utilization review responsibilities. Superior organization and time management skills required;… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …staff quality audits to ensure compliance of Emory Healthcares Utilization Review Plan, regulatory guidelines, and department policies and procedures. ... + Assist with communication between the Hospitals Case Management Department and Utilization Review Department. + Assist with representing the Utilization… more
- CenterLight Health System (NY)
- …of experience in care/case management , disease management , population health management , utilization review , quality assurance, or discharge ... escalate issues of changes to ensure proper care and management of cases are followed. + Promotes and educates...Escalates questions or concerns during the assessment to the quality review team to ensure appropriate completion… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well… more
- Providence (Mission Hills, CA)
- **Description** Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost ... License upon hire + 3 years of experience in utilization management and/or case management ....line within Providence serving patients across seven states with quality , compassionate, coordinated care. Collectively, our medical groups and… more
- Covenant Health (Nashua, NH)
- …the health care team. + Annual goals are achieved. + Attends pertinent case management / utilization review programs to maintain current knowledge of UR ... Summary Conducts medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed on a nursing unit, to include… more
- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, ... more at UCLA Health. You will play a key part in promoting high- quality , cost-effective medical care by applying clinical acumen and applicable policies and… more