- Kelsey-Seybold Clinic (Houston, TX)
- …center (ASC). The Utilization Review Specialist (LVN) will support the Utilization Review quality assurance initiatives including mock audits to ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible...as we continue to grow, our focus is providing quality patient care by adding to our team of… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Utilization Review / Quality Assurance Sr. Coordinator will be responsible for providing clinical information to managed care companies as ... regulatory agencies, and other health care related entities. Preferred Qualifications: Utilization Review /Managed Care/ Quality Assurance experience.… more
- WMCHealth (Valhalla, NY)
- …hospital or health care agency, one of which must have been in the area of utilization review , quality assurance , risk management or discharge planning. ... the implementation or investigation of the procedures specified in the Quality Management, Utilization Review and Discharge Planning Program at Westchester… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …management, including the principles and practices of discharge planning, utilization review , and quality assurance /improvement. + Knowledge of the ... responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity ... using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity… more
- Centene Corporation (Phoenix, AZ)
- … quality improvement activities. + Performs medical review activities pertaining to utilization review , quality assurance , and medical review ... Canadian Board certification and/or American Board of Quality Assurance & Utilization Review Physicians (ABQAURP) Board credentials. Current Arizona… more
- Beth Israel Lahey Health (Burlington, MA)
- …coordinates utilization review , discharge planning and monitors quality assurance for Lahey Clinic inpatient admissions. Leads the multidisciplinary ... in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient...needed. 10) Supports all service line activities related to utilization and quality management. 11) Assists in… more
- Stanford Health Care (Palo Alto, CA)
- …case management, including the principles and practices of discharge planning, utilization review , and quality assurance / improvement * Knowledge of the ... responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient… more
- Stanford Health Care (Palo Alto, CA)
- …case management, including the principles and practices of discharge planning, utilization review , and quality assurance / improvement + Knowledge of the ... responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …management, including the principles and practices of discharge planning, utilization review , and quality assurance /improvement. + Knowledge of the ... direction, and management of the staff and day-to-day activities of Case Management/ Utilization Review , one of two major organizational components (the other… more
- University of Miami (Miami, FL)
- …care organizations and the hospital regarding benefit coverage issues, utilization review , and quality assurance processes. + Identifies trends in ... including but not limited to intake, discharge planning, case management, utilization review , resource management, care navigation, and patient placement… more
- MTC (Bryan, TX)
- …co-dependency, and related disorders. 2. Performs complex technical assistance work; implements quality assurance utilization review procedures; and ... and procedures. 3. Assists in monitoring, reviewing, interpreting, and evaluating quality of services; assists in compiling and analyzing data and preparing… more
- MTC (San Diego, TX)
- …productive life. **Essential Duties:** 1. Performs complex technical assistance work; implements quality assurance utilization review procedures; and ... policies, and procedures. 2. Assists in monitoring, reviewing, interpreting, and evaluating quality of services and success of programs; assists in compiling and… more
- University of Maryland, Baltimore (Baltimore, MD)
- …Directs activities related to the delivery of medical care and clinical services such utilization review , quality assurance , policies, procedures and ... operational, and leadership skills and experience in neonatal care, quality , and safety to lead the clinical service. The...clinical and reimbursement activity. 7. Participates in the Peer Review Program as described in the Medical Staff Bylaws… more
- Matrix Providers (Aurora, CO)
- … Quality and Management (HCQM) through American Board of Quality Assurance and Utilization Review Physicians (ABQARP) + Certified Informatics Nursing, ... Utilization Review Nurse (RN) Location: Aurora,... Utilization Management Accreditation through National Committee for Quality Assurance (NCQA) are desired. Experience: Minimum… more
- US Tech Solutions (Columbia, SC)
- …quality of care issues. **Experience:** + 2 years clinical experience plus 1 year utilization /medical review , quality assurance , or home health, OR, 3 ... principles. Knowledge of National Committee for Quality Assurance (NCAG). Knowledge of Utilization Review... Quality Assurance (NCAG). Knowledge of Utilization Review Accreditation Commission (URAC). Knowledge of… more
- ManpowerGroup (Columbia, SC)
- …Work, Psychology, or Counseling. + 2 years of clinical experience plus 1 year in utilization /medical review , quality assurance , or home health, or 3 ... their team. As a Reviewer III, Medical, you will be part of the Utilization Management department supporting the medical review team. The ideal candidate will… more
- CenterLight Health System (NY)
- …(5+) years of experience in care/case management, disease management, population health management, utilization review , quality assurance , or discharge ... model. + Escalates questions or concerns during the assessment to the quality review team to ensure appropriate completion of UAS-NY and handling of on-site… more
- Ochsner Health (New Orleans, LA)
- …(ACPA) or (2) Board Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (3) Physician Advisor ... Sub-Specialty Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (4) commitment to apply for such… more
- Actalent (Flushing, NY)
- …5+ years of experience in care/case management, disease management, population health management, utilization review , quality assurance , or discharge ... on plan benefits and services. + Escalate questions or concerns to the quality review team for appropriate handling. + Complete and/or reassess the PCAT Tasking… more