- Novo Nordisk Inc. (West Hollywood, CA)
- …assess, create and maintain advocacy of customers aligned to company, brand and clinical goals. The OCS develops local strategies and executes local tactical plans ... partners. The OCS also assists their customers with their local clinical and educational initiatives by coordinating company resources (eg, counterparts, materials,… more
- Community Health Systems (Franklin, TN)
- …works with the physicians on the medical staff hospital's to perform an internal secondary review . The UR Clinical Specialist may assist coordinating a Peer ... medical services and procedures in a Behavioral Health setting. Utilization review is the assessment for medical...the case management system by the UR Behavioral Health Review Specialist . + UR Clinical … more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for ... payer requirements. These discussions are to help the UR Clinical Specialist understand the reason for admission,...documentation from the physician(s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if… more
- BayCare Health System (Clearwater, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions ... discounts and more _Equal Opportunity Employer Veterans/Disabled_ **Position** Utilization Review Spec Sr **Location** Clearwater:Morton Plant | Clinical |… more
- Spectrum Billing Solutions (Skokie, IL)
- …Excel, billing software). + Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management ... will utilize his or her knowledge and skills to review clinical information and obtain initial and... | UR Specialist | Revenue Cycle Utilization Review Specialist | ABA… more
- 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 ... and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and transitions… more
- CaroMont Health (Gastonia, NC)
- …RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal ... NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case...Case Management preferred. Minimum of three years experience in clinical area with clinical review … more
- Munson Healthcare (Traverse City, MI)
- …families, interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic ... Nurse in the State of Michigan. + Minimum of three years clinical experience required. Previous utilization review and/or case management in a hospital or… more
- Lawrence General Hospital (Lawrence, MA)
- The Utilization Review Specialist , under supervision and in collaboration with the Utilization Review Coordinator, Utilization Review Nurses, ... well as the integrated care team and supports the case management/ utilization review team on system-wide quality improvement/performance improvement initiatives.… more
- HCR Home Care (Rochester, NY)
- Role and Responsibilities The Utilization Review Specialist is responsible for performing utilization review activities including technical audit of ... technical audit of CHHA and LHCSA records: + Conduct review of clinical documentation in patient medical...action as needed. + Provide staff training for new Utilization Review initiatives and monitors the performance… more
- Sutter Health (Berkeley, CA)
- …and others to ensure appropriate utilization and quality care through utilization review , tracking and evaluation and objectively compare criteria with ... nursing staff and other departments regarding documentation required for utilization review activities and processes. Collaborate with medical, nursing… more
- Bakersfield Behavioral Healthcare Hospital (Bakersfield, CA)
- …leadership, teamwork, and communication skills. ESSENTIAL DUTIES The primary responsibility of the Utilization Review Specialist is to review medical ... of candidates. Education Associates Degree preferred Minimum Work Experience Utilization Review experience preferably in a behavioral/psychiatric healthcare… more
- HonorHealth (Scottsdale, AZ)
- …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization,… more
- Westborough Behavioral Healthcare Hospital (Westborough, MA)
- …Time + Employee Discount Program + Employee Assistance Program Job Description: The Utilization Review Specialist is responsible for monitoring adherence to ... Westborough Behavioral Healthcare Hospital is looking for a UR Specialist to provide Per Diem coverage. Benefits Include +...the hospital's utilization review plan to ensure the effective… more
- Medical Center Hospital (Odessa, TX)
- Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician...as a Registered Nurse. Training and Experience: Three years clinical nursing experience in general medical/surgical setting or appropriate… more
- Desert Parkway Behavioral Healthcare Hospital (Las Vegas, NV)
- The UR Specialist reviews and monitors patients' utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties ... include providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency...times. + Addresses care issues with the Director of Clinical Services and Chief Medical Officer/Medical Director as appropriate.… more
- Reno Behavioral Healthcare Hospital (Reno, NV)
- The UR Specialist reviews and monitors patients' utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties ... include providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency...times. + Addresses care issues with the Director of Clinical Services and Chief Medical Officer/Medical Director as appropriate.… more
- WestCare Foundation (Henderson, NV)
- Utilization Review Specialist Job Details Job Location Henderson - 1711 Whitney Mesa - Henderson, NV Position Type Full Time Education Level 2 Year Degree ... LPN or RN and/or Bachelors or Masters level CADC/LADC with 2 years utilization review experience, preferred experience working with individuals with psychiatric… more
- CaroMont Health (Gastonia, NC)
- Job Summary: The Pre-Authorization Specialist is a member of the Utilization Review Department who is responsible for verifying eligibility, obtaining ... authorizations for care, via phone, fax, or payer websites. The Pre-Authorization Specialist provides detailed and timely communication to both payers and … more
- Alameda Health System (Oakland, CA)
- …clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post discharge ... System Utilization Management Specialist + Oakland, CA...6. Functions as a key point of contact between clinical Utilization management staff, admissions and payors.… more
