• Utilization Physician

    BayCare Health System (Tampa, FL)
    …of the Utilization Physician Reviewer is to optimize utilization physician review coverage resulting in reduction of inappropriate prolonged ... on a foundation of trust, dignity, respect, responsibility and clinical excellence. ** Utilization Physician Reviewer position details:** + **Facility:** St.… more
    BayCare Health System (01/11/25)
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  • Utilization Review Physician

    Hackensack Meridian Health (Hackensack, NJ)
    **Overview** **The Utilization Review Physician 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
    Hackensack Meridian Health (11/02/24)
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  • Physician Utilization Review

    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
    Hackensack Meridian Health (11/18/24)
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  • Utilization Review Specialist,…

    Sutter Health (Berkeley, CA)
    …and others to ensure appropriate utilization and quality care through utilization review , tracking and evaluation and objectively compare criteria with ... clinical nursing staff and other departments regarding documentation required for utilization review activities and processes. Collaborate with medical, nursing… more
    Sutter Health (10/24/24)
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  • Utilization Review Specialist

    Lawrence General Hospital (Lawrence, MA)
    …supervision and in collaboration with the Utilization Review Coordinator, Utilization Review Nurses, Physician advisor and healthcare team supports ... well as the integrated care team and supports the case management/ utilization review team on system-wide quality improvement/performance improvement initiatives.… more
    Lawrence General Hospital (12/21/24)
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  • System Physician Advisor

    CommonSpirit Health (Phoenix, AZ)
    …both inside our hospitals and out in the community. **Responsibilities** As the Utilization Management Physician Advisor (PA), the PA conducts clinical case ... objectives for providing quality patient care, to assure effective and efficient utilization of health care services. The PA communicates remotely with case and… more
    CommonSpirit Health (12/23/24)
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  • Physician Advisor Denials Management

    CommonSpirit Health (Englewood, CO)
    …both inside our hospitals and out in the community. **Responsibilities** The Utilization Management Physician Advisor II (PA) conducts clinical case reviews ... hospital's objectives for assuring quality patient care and effective and efficient utilization of health care services. This individual meets with case management… more
    CommonSpirit Health (12/23/24)
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  • Director of Physician Services I

    HCA Healthcare (Idaho Falls, ID)
    …such as patient flow, patient satisfaction, practice volume, billing and collections, service utilization , coding, physician and staff training + You will have ... 156,000 hours impacting our communities. As a Director of Physician Services I with East Falls Primary Care, you...medical records, nursing, and ancillary services to ensure maximum utilization of resources and the efficient delivery of services… more
    HCA Healthcare (12/24/24)
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  • Utilization Review RN

    Beth Israel Lahey Health (Boston, MA)
    …a difference in people's lives.** Position Summary: In conjunction with the admitting/attending physician , the Utilization Review RN assists in determining ... the level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure… more
    Beth Israel Lahey Health (12/12/24)
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  • PRN Utilization Review Clinical…

    Community Health Systems (Franklin, TN)
    …additional documentation from the physician (s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if physicians are ... appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for… more
    Community Health Systems (01/08/25)
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  • Utilization Review Clinical…

    Community Health Systems (Franklin, TN)
    …additional documentation from the physician (s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if physicians are ... and efficiency of medical services and procedures in a Behavioral Health setting. Utilization review is the assessment for medical necessity, both for admission… more
    Community Health Systems (01/08/25)
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  • Director Physician Development MSMC

    Methodist Health System (Southlake, TX)
    …visits for employees to physicians/offices per month. Create reports to monitor physician utilization trends and communicate that information to directors and ... behalf of the hospitals for the purpose of increasing utilization of outpatient services and building physician ...increasing utilization of outpatient services and building physician loyalty. Methodist Southlake Medical Center is a 54-bed,… more
    Methodist Health System (11/20/24)
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  • Physician Advisor - Houston Methodist

    Houston Methodist (The Woodlands, TX)
    …The Physician is a key member and leader of the hospital's utilization review /management committee, which is charged with regulatory goals of ensuring high ... of care, length of stay, and quality issues. + Chair the utilization review /management committee, actively participates in defining operational strategic… more
    Houston Methodist (11/21/24)
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  • Physician Advisor

    Mohawk Valley Health System (Utica, NY)
    …specialist regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of...and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides… more
    Mohawk Valley Health System (12/18/24)
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  • Utilization Management Reviewer

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …us transform healthcare? Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care for members who may have ... eligible for the following personas: eWorker, mobile and resident. The Team The Clinical Utilization Reviewer is part of a highly dedicated and motivated team of… more
    Blue Cross Blue Shield of Massachusetts (01/03/25)
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  • Utilization Clinical Reviewer

    Kepro (Los Angeles, CA)
    Reviewer to join our growing team in California. Job Summary As a Utilization Clinical Reviewer , you will leverage your expertise to meticulously assess ... will evaluate the medical necessity of psychiatric inpatient care to ensure appropriate utilization of services. This role is pivotal in maintaining the accuracy and… more
    Kepro (12/10/24)
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  • Insurance Verification and Utilization

    Community Health and Counseling Services (Bangor, ME)
    Insurance Verification and Utilization Review Specialist - Health Services Job Type(s):Full-Time Location(s):Bangor, Maine Education:Associates Degree - Business ... collaborating with Agency staff, patients, family members, facilities and physician . Responsible for utilization management of services, verifying… more
    Community Health and Counseling Services (01/08/25)
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  • Physician Reviewer BH PRU, Part Time

    Blue Cross Blue Shield of Massachusetts (Boston, MA)
    …adjudicate these requests. At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical ... transform healthcare? Bring your true colors to blue. The Physician Reviewer is responsible for evaluating clinical..., in partnership with case managers + Participate in Physician Psychologist Review Units' appeal process of… more
    Blue Cross Blue Shield of Massachusetts (01/11/25)
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  • Physician Clinical Reviewer

    Evolent (Columbus, OH)
    utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer you will be a... you will be a key member of the utilization management team. We can offer you a meaningful… more
    Evolent (12/15/24)
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  • Utilization Review Nurse Supervisor…

    The County of Los Angeles (Los Angeles, CA)
    …Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician member of the ... UTILIZATION REVIEW NURSE SUPERVISOR II Print...by subordinate supervisors on number and status of reviews, physician advisor referrals, and type of physician more
    The County of Los Angeles (12/29/24)
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