- HCA Healthcare (Nashville, TN)
- …The Utilization Review Services (URS) Director of Denial Operations collaborates with Case Management , Parallon, Regulatory Compliance and ... payor relations and reduce denials. + Monitors effectiveness of Denial Management Action Teams across the enterprise...Compliance policies, and quality initiatives as it relates to utilization management . + Works directly with CM… more
- CaroMont Health (Gastonia, NC)
- …CDS and Denial Specialist will work collaboratively with Health Information Management , Utilization Review and Clinical Documentation Specialist to ... is a split role between CDS workflow and DRG Denial Management and Appeals based on departmental...recoup revenue. This position also facilitates collaboration between the Utilization Review Specialist's, Coding staff, HIM staff,… more
- AdventHealth (Altamonte Springs, FL)
- …license **Preferred Qualifications:** . Advanced degree in any field of study . Experience in denial management , utilization review , case management , ... about the best opportunity for fair reimbursement. The Clinical Denial Management Specialist will adhere to the...have at least an Associate's Degree in Nursing) . Utilization Review / Utilization Management … more
- Baylor Scott & White Health (Dallas, TX)
- …+ Worked on the payer (Insurance) side of appeals and denials. + Experience in Utilization Review and Case Management . **Essential Functions of the Role** + ... **Job Summary** You, as a Registered Nurse in the Denial Resource Center at Baylor Scott & White Health,...earnestly participating in their implementation. + By closely examining denial trends, you will categorize them based on impacts… more
- Sutter Health (Sacramento, CA)
- …EXPERIENCE:** * 8 years of recent relevant experience. * 2 years experience in Utilization Management (UM) and Clinical Denial Management Preferred ... System Office-Valley **Position Overview:** Manages the operations of the centralized Utilization review department for Sutter Health entities in accordance… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management ...they pertain to level of care determination and the appeal/ denial process. + Oversees utilization review… more
- Dignity Health (Phoenix, AZ)
- …operations to ensure effective utilization reviews, strict adherence to denial management processes, andcompliance with established policies and procedures. ... clinical field + Minimum 5 years of clinical case management ( Utilization Management , Denial...and review requirements + In-depth knowledge of utilization management processes and best practices +… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management , and transitions of ... Criteria ( ie MCG, Xsolis) b. Supports & Participates in pre-admission review , utilization management , and concurrent and retrospective review… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management , and transitions of ... Criteria ( ie MCG, Xsolis) b. Supports & Participates in pre-admission review , utilization management , and concurrent and retrospective review… more
- Sutter Health (Sacramento, CA)
- …resources, medical necessity, documentation best practices, level of care progression, denial management and compliance with governmental regulations and ... with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management...within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation… more
- Henry Ford Health System (Troy, MI)
- …required. * Bachelor of Science Nursing required OR four (4) years Case Management / Appeal/ Utilization Management experience in lieu of bachelor's degree. ... Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered.… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …with resources to help you flourish and leaders who care about your success. The Utilization Review RN is responsible for the review of medical records ... utilizing evidence-based guidelines and critical thinking. Additionally, as a Utilization Review RN, you will collaborate with...Review RN, you will collaborate with the Concurrent Denial RNs to determine the root cause of denials… more
- Dignity Health (Santa Maria, CA)
- …Abilities, and Training** * Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used * Proficient in application of clinical ... effectively with multiple stakeholders * Professional communication skills * Understand how utilization management and management programs integrate. *… more
- Baptist Memorial (Jackson, MS)
- … management , medical necessity reviews, verification of authorization, resource utilization , and denial prevention. Responsibilities + Completes and enters ... Overview Summary The Utilization Review Nurse is responsible for...clinical knowledge, attention to detail communication, organization, interpersonal, time management and computer skills. Problem solving; and knowledge of… more
- Catholic Health Services (Melville, NY)
- …queries from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, ... to remain current with industry standards and business objectives related to Utilization and Care Management as appropriate. Sound knowledge and skill… more
- Catholic Health Services (Melville, NY)
- …from payors for additional clinical documentation. |Acts as liaison between the Utilization and Appeals Management Department and the physician of record, ... to remain current with industry standards and business objectives related to Utilization and Care Management as appropriate. |Sound knowledge and skill… more
- Ochsner Health (New Orleans, LA)
- …of stay management and utilization of resources + Assist with the denial management process + Review medical records of patients identified by case ... at Ochsner Health and discover your future today!** The Physician Advisor (PA- Utilization Management ) serves as the physician leader in matters relating… more
- Dartmouth Health (Lebanon, NH)
- …Documents activity and provides information upon request. * Maintains ongoing monitoring of Denial Management system and takes action based on status of ... denial . Enters all paper denials into the Denial System. * Coordinates with Revenue Management and Patient Access staff around medical necessity denials that… more
- Sanford Health (SD)
- …$41.50 **Job Summary** Provides clinical support to the MCHS revenue cycle for denial management and clinical workflows within the patient financial service ... and services. Provide feedback and education to other departments for denial prevention. Provide clinical insight into issues preventing insurance billing from… more
- Hackensack Meridian Health (North Bergen, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management ** is a member of the healthcare team and is ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more