- Northeast Georgia Health System, Inc (Gainesville, GA)
- …and present periodic reports on the departments including quality, costs, profitability, physician utilization , market share, as well as potential opportunities ... and visibility across all campuses. Responsibility includes the vision, direction, management and coordination of clinical invasive cardiac services, and vascular… more
- A-Line Staffing Solutions (Grand Rapids, MI)
- …care according to persons served care needs. * In collaboration with the physician , provides/coordinates nursing care to individuals and groups of persons served. * ... in the teaching of persons served families, and provides milieu management . Communicates with and educates persons served families/significant others in… more
- Intermountain Health (Las Vegas, NV)
- …health plan criteria, MCG criteria, and state, local, or federal guidelines relating to utilization management . + Demonstrated knowledge of case management , ... **Job Description:** This position interacts with UM physician and operational leadership. As the UM ...work experience related to inpatient management , case management , utilization management , quality … more
- Trinity Health (Darby, PA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The Appeals and Utilization Management Coordinator under direction and in collaboration with ... the RN Care Coordination Manager, provides support to the utilization management , denials and appeals process for...and processing the review to be conducted by the Physician Advisor to ensure all deadlines are met +… more
- Trinity Health (Boise, ID)
- …of two years' experience in hospital based medicine with exposure to utilization management and documentation initiatives. 3. Demonstrated teamwork, performance ... the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is the lead provider for coordination and… more
- Huron Consulting Group (Chicago, IL)
- …standards. + Participate in quality assurance activities to improve utilization management processes and patient care outcomes. + Lead UM Denials Team ... you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring...daily Staff Huddles for operations and priorities review. + Lead Patient Care Management Escalation Huddles to… more
- The Cigna Group (Franklin, TN)
- The Chief Medical Officer (CMO) Utilization Management will develop and manage efforts to improve and maintain cost and utilization trends. Responsible for ... departments of insurance, and similar accreditors/regulators for the performance of all utilization management (UM) programs across the enterprise. The CMO is… more
- Kepro (Indianapolis, IN)
- …partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job ... innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra...Summary: Our Utilization Management Appeals Nurse - LPN/RN will… more
- State of Connecticut, Department of Administrative Services (Wallingford, CT)
- Utilization Review Nurse Coordinator Hybrid Recruitment # 240624-5613FP-001 Location Wallingford, CT Date Opened 6/27/2024 12:00:00 AM Salary $86,261 - $116,571/year ... has a full-time (1st shift) job opportunity for a Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=) , in the Private… more
- Dignity Health (Bakersfield, CA)
- …Summary:** The Utilization Review LVN uses clinical judgement in providing utilization management services. The focus is to provide high quality ... Qualifications:** - Minimum 3-5 years of healthcare experience with general knowledge of Utilization Management and Managed Care. - Graduate of accredited school… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Lead Nurse Practitioner/ Physician Assistant (NP/PA) position is responsible for functioning as a clinical leader and scholar at the ... as a preceptor by mentoring others regarding care of defined populations in resource utilization and time management . + Provides clinical guidance as a Nurse… more
- Trinity Health (Livonia, MI)
- …cases that are appropriate and communicating to Insurance Verification and Health Information Management . * Functions as a resource to physician , hospital staff ... / MCG criteria to determine appropriate level of care. * Follows the hospital Utilization Review Plan to ensure effective and efficient use of hospital services. *… more
- Trinity Health (Syracuse, NY)
- …10,000 sign-on retention bonus for qualified experienced RN's. The Registered Nurse Utilization Review (UR), Clinical Care Manger (CCM) actively manages the ... utilization review process and patient progression from Admission to...and status. + Uses Interqual and Indicia/MCG software and Physician Advisors to determine appropriate patient status/level of care.… more
- Dignity Health (Bakersfield, CA)
- …Office applications; Excel, Word, Outlook. **Preferred Qualifications:** - Utilization management (UM)/prior authorization experience strongly preferred. ... Organization (Dignity Health MSO) is to build a system-wide integrated physician -centric full-service management service organization structure. We offer a… more
- Catholic Health Services (Melville, NY)
- …and management ; contributes to completion of project status reports. Lead meetings with staff and/or leadership to assist in establishing project priorities ... a home health service, hospice and a network of physician practices across the island. At Catholic Health, our...and managing resources) and all phases of the project management life cycle for a variety of initiatives Actively… more
- Kepro (Los Angeles, CA)
- …expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an ... a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team. Job Summary As a Utilization… more
- University of Washington (Seattle, WA)
- …. ** LEAD APP, TRAUMA ICU ( LEAD NURSE PRACTITIONER OR PHYSICIAN ASSISTANT)** ... ARNP or PA-C) will, in collaboration with an attending physician , examine, diagnose and treat acute health problems. Responsibilities...and managing minor trauma and acute health problems. The Lead APP also leads and mentors other APPs in… more
- Stanford Health Care (Palo Alto, CA)
- …one of the Nation's most prestigious Cardiothoracic Surgery teams as an APP Leader. You will lead a team of APPs as well as have your own OR and Clinic time. We ... mission one patient at a time. **A Brief Overview** Provides supervision and management of advanced practice providers (APPs) in a distinct clinical service line.… more
- Kepro (Los Angeles, CA)
- …expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an ... for health solutions in the public sector. Position Overview: As a Utilization Reviewer, you involves reviewing medical records against appropriate criteria and… more
- Tufts Medicine (Burlington, MA)
- …on quality, ethical, regulatory, and/or financial topics related to patient care, utilization management /review, case management , and revenue cycle ... provider documentation queries. 12.Works with leaders to monitor appropriate utilization management and clinical documentation improvement performance and… more
