- 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, ... in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely...for appropriate care and setting while working closely with denial coordinators and other staff to ensure the accurate… more
- Prime Healthcare (Philadelphia, PA)
- …coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for ... all communication attempts with insurance providers and health plans. Utilization review tech will follow up on...Education and Work Experience 1. Minimum one year denials management experience in acute care setting highly preferred.2. High… more
- Prime Healthcare (Joliet, IL)
- …coordinate the utilization review and appeals process as part of the denial management initiatives. + Utilization review tech is responsible for ... and scan all related correspondence to the respective EMR/ tracking tool. + Utilization review tech will follow up on all denials while working closely with the… 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
- Sutter Health (Sacramento, CA)
- …Hire **TYPICAL EXPERIENCE:** 8 years of recent relevant experience. 2 years experience in Utilization Management (UM) and Clinical Denial Management ... 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)
- …payer contract changes as they pertain to level of care determination and the appeal/ denial process. + Oversees utilization review workflow processes to ... a job, you're making a difference in people's lives.** MANAGER, UTILIZATION REVIEW & DENIALS MGMT **Job Description:**...+ Minimum of 3 years of progressive experience in utilization management and appeal/ denial … more
- Sutter Health (Berkeley, CA)
- …for the appeal/ denial process, tracks and trends data, and coordinates utilization management activities for the assigned area. Collaborates with hospital ... and others to ensure appropriate utilization and quality care through utilization review , tracking and evaluation and objectively compare criteria with… 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
- Dignity Health (Northridge, CA)
- …than 400 care centers. Visit dignityhealth.org/northridgehospital for more information. Northrdige Hospital Utilization Review RN Utilization Review ... and continued stay authorizations as required within the market. \#LI-DH \#RN \# Utilization Review RN **Responsibilities** + Conducts admission and continued… more
- Providence (Olympia, WA)
- …+ Previous healthcare administration and/or delivery of healthcare services + Utilization Management / Review **Preferred Qualifications:** + Bachelor's Degree ... **Description** The Supervisor for Utilization Management provides a key role...Commissions. Knowledge of reimbursement requirements and strategies. Knowledge of denial process and denial appeal management… more
- Kelsey-Seybold Clinic (Houston, TX)
- … Utilization Review Specialist (LVN)** **Location: Remote** **Department:** ** Utilization Management ** **Job Type: Full Time** **Salary Range: $60,306 - ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible...Review Specialist (LVN) is responsible for completion and review of denial letters based on Texas… more
- MetroHealth (Cleveland, OH)
- …and time management skills. Preferred: Two years of experience with case management , utilization review . Physical Demands: May need to move around ... level of care at the point of entry. The utilization review nurse will work on defined...to develop and participate in a systematic approach to denial management , and in so doing reduce… more
- Community Health Systems (Franklin, TN)
- …clinics, imaging centers, cancer centers and ambulatory surgery centers. **Summary:** Utilization management is the analysis of the necessity, appropriateness, ... of medical services and procedures in the hospital setting. Utilization review is the assessment for medical...presenting after the call and documented in the case management system by the UR Review Specialist.… more
- UPMC (Hanover, PA)
- **UPMC is hiring a part time Professional Care Manager for our Utilization Review department in Hanover! This is a part time, day shift position with a rotating ... the clinical and financial plan for patients. Performs overall utilization management , resource management , discharge...for JCAHO requirements. + Takes leadership role in concurrent denial process. Works with Care Management Director,… 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
- 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
- HonorHealth (Scottsdale, AZ)
- …Facilitates peer to peer review with payer as directed. Retrieves utilization management clinical requests and handles each appropriately according to ... Director of Care Coordination and Clinical Value, assists in the administration of Utilization Management functions to include, but not limited to, organization… more
- Baptist Memorial (Jackson, MS)
- … management , medical necessity reviews, verification of authorization, resource utilization , and denial prevention. Responsibilities + Completes and enters ... 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)
- …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