- Methodist Health System (Celina, TX)
- …Your Responsibilities: * Assures that appropriate application of internal and external utilization criteria for MMC patients * Acts as resource for staff regarding ... * Identifies opportunities for improved performance to Medical Management staff regarding denial management * Leads orientation of new staff in accordance with… more
- St. Luke's University Health Network (Allentown, PA)
- …after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications. The appeals process may include collaboration ... Medical Coder who ensures clean claim submission and timely review and resolution of coding related claim denials for...single or low volume errors. Report high volume coding denial trends to the coordinator + Maintain… more
- Desert Parkway Behavioral Healthcare Hospital (Las Vegas, NV)
- …that all days are authorized and identify denied days, coordinate with Director of Utilization Review and add to Denial Tracker when appropriate. Monitor ... designated appeal documents in doc link. Reviews with UR Director per denial tracker updates. Maintains file of copied appeals for resolution. Discharge… more
- Hackensack Meridian Health (Hackensack, NJ)
- …**Hackensack Meridian** **_Health_** includes: + Follows departmental workflows for utilization review activities including admission reviews, admission denials, ... to transform healthcare and serve as a leader of positive change. The **Care Coordinator , Utilization Management** is a member of the healthcare team and is… more
- Hackensack Meridian Health (Holmdel, NJ)
- …at Hackensack Meridian _Health_ includes: + Follows departmental workflows for utilization review activities including admission reviews, admission denials, ... to transform healthcare and serve as a leader of positive change. The **Care Coordinator , Utilization Management** is a member of the healthcare team and is… more
- Trinity Health (Syracuse, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The RN Utilization Management Nurse Coordinator is responsible for both concurrent and ... retrospective inpatient and outpatient services, in accordance with the utilization requirements and 3rd party payor contracts. The UM...workflow development in the UMCC department, gather and renew denial metrics, review and evaluate LOS O/E… more
- Sharp HealthCare (San Diego, CA)
- … Coordinator , under the direct supervision of the Supervisor, Utilization Management Care Coordinators, prepares referral requests for outpatient services, ... well as the SCMG operation documents as appropriate for approval at the UM Care Coordinator level of review .Appropriately identify claims for review by the… more
- UCLA Health (Los Angeles, CA)
- …by Case Management + Work directly with a nurse team lead + Review pending claims for approval or denial Salary Range: $34.37- $47.31/hourlyQualifications ... more at UCLA Health. Under the direction of the Utilization Management, Assistant Manager, you will play a key...and prepare necessary documents for the next level of review + Maintain and prepare specific reports and manage… more
- Baptist Memorial (Memphis, TN)
- Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and appropriateness of healthcare services and treatment as prescribed ... by utilization review standards. The UR Nurse works...status management, medical necessity reviews, verification of authorization, resource utilization , and denial prevention. Responsibilities + Completes… more
- UNC Health Care (Goldsboro, NC)
- …of applied clinical experience as a Registered Nurse required. * 2 years utilization review , care management, or compliance experience preferred. * Minimum 1 ... unique communities we serve. Summary: Coordinates and leads all clinical denial processes and clinical audit activities. Supervises and collaborates with teammates.… more
- HCA Healthcare (Lewisville, TX)
- …and personal growth, we encourage you to apply for our Administrative Coordinator opening. We promptly review all applications. Highly qualified candidates ... **Description** **Medical City Lewisville** **Ortho Care Coordinator ** **Full Time** **Days** **Introduction** Are you passionate about the patient experience? At… more
- Baptist Memorial (Memphis, TN)
- …information documentation and transmission vital to the effectiveness of utilization review and supporting Baptist's reimbursement strategy. Specifically ... the managed care techniques the Coordinator uses focuses on prior authorization for services using...Communicates incorrect payer with patient access + Communicate with Utilization Review Nurse + Works assigned queues… 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 ... agencies, and other health care related entities. Preferred Qualifications: Utilization Review /Managed Care/Quality Assurance experience. Experience in the… more
- University of Virginia (Haymarket, VA)
- …in a medical setting. The purpose is to achieve the goals and to meet the denial rates set by Patient Access, the Medical Center and HSF to ensure minimum loss of ... your understanding! ** + Utilizes clinical knowledge, payor contracts, medical review policies, supporting research, and any other relevant documentation to… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Pre-Transplant Coordinator position a registered nurse, responsible for participating in department initiatives, facilitating, and ... Coordinators and management, benefiting from their practice. The Pre-Transplant Coordinator position interacts with all members of interprofessional transplant team… more
- Brockton Hospital (Brockton, MA)
- …delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare ... management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience required.… more
- Ellis Medicine (Schenectady, NY)
- …relationships with payers and communicates confidential information per policy. + Assists Utilization Management with initial clinical review requests as needed. ... function is to work with the Social Worker, Nurse Case Manager, or Utilization Management Nurse to facilitate patient discharge plans, support coordination of care… more
- Hackensack Meridian Health (Neptune, NJ)
- …information, inclusive of free text fields, to support the case management, utilization review process. + Retrieves information for the Physician Advisors ... accounts as appropriate. + Verifies admission and discharge date information. + Updates Utilization Review RN needed for payors. + Enters all documentation into… more
- State of Colorado (Pueblo, CO)
- …program, this position may be asked to participate in various aspects of utilization review . For example, compose clinical letters in reply to third-party ... criteria, which includes, but is not limited to, visual review of video footage, performing interviews alone with staff...payer denial for reimbursement, and auditing the medical record to… more
- The County of Los Angeles (Los Angeles, CA)
- …and students in the allied health fields. Instructs community agencies regarding the utilization of mental health principles to identify and to treat mental health ... mental health problems and to improve therapeutic treatment methods. May review treatment authorization requests from hospitals, contracted network and/or legal… more