- Beth Israel Lahey Health (Plymouth, MA)
- …you're not just taking a job, you're making a difference in people's lives.** MANAGER, UTILIZATION REVIEW & DENIALS MGMT **Job Description:** Beth Israel ... of care determination and the appeal/denial process. + Oversees utilization review workflow processes to ensure timely...review workflow processes to ensure timely response to denials . + Maintains a database to track level of… 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 ... all denials and is key point person for assigning team review . ie denials to Coding Supervisor. 4. Reviews and documents findings on all medical necessity… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical ... and tracks outcomes regarding appeal process. Assists billing staff regarding outpatient denials for experimental, coding or other issues that may require record … more
- AdventHealth (Altamonte Springs, FL)
- …in non-nursing field, must have at least an Associate's Degree in Nursing) . Utilization Review / Utilization Management experience of at least 2 years ... degree in any field of study . Experience in denial management, utilization review , case management, clinical documentation improvement, revenue integrity, or… more
- CommonSpirit Health (Phoenix, AZ)
- …both inside our hospitals and out in the community. **Responsibilities** The Utilization Management Physician Advisor II (PA) conducts clinical case reviews referred ... hospital's objectives for assuring quality patient care and effective and efficient utilization of health care services. This individual meets with case management… more
- Kaleida Health (Buffalo, NY)
- …conventions and insurance / managed care practices including but not limited to: utilization review , RAC, MAC, Q10, clinical and DRG denial management required. ... **Director Clinical and DRG Denials ** **Location:** Larkin Bldg @ Exchange Street Location...successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan and, assists… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …RN License in Applicable State of Employment required + 3 years of nursing utilization review preferred + Experience working with EMR preferred. + Working ... to help you flourish and leaders who care about your success. The Denials Management RN is responsible and accountable for receiving, processing and documenting all… more
- Insight Global (Skokie, IL)
- …. Skills and Requirements 3+ years experience as a utilization review nurse Experience reviewing and analyzing denied ... As a Clinical Denials Specialist you will be working with the denials team to review and analyze denials from a clinical perspective. This person will be… more
- St. Luke's University Health Network (Allentown, PA)
- …role is a Certified Medical Coder who ensures clean claim submission and timely review and resolution of coding related claim denials for professional services, ... after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications. The appeals process may include collaboration… more
- BrightSpring Health Services (Louisville, KY)
- …therapy from an accredited or approved school.* Two years of experience in health care utilization review or home care.* Two years prior home health or hospice ... Our Company BrightSpring Health Services Overview Director of Clinical Denials Management and Audit supervises a team of RN/LPN clinical reviewers as well as Support… more
- LifePoint Health (Brentwood, TN)
- …secure approval for business cases to support comprehensive programs to prevent payer denials . * Implement centralized utilization review and authorization ... years of clinical experience in an acute care setting managing utilization review , medical necessity and denials management.Experience leading education… more
- Lawrence General Hospital (Lawrence, MA)
- The Utilization Review Coordinator functions as the primary liaison between the hospital, payor contacts, and all other related parties to ensure appropriate ... and the utilization of ancillary services. The Utilization Review Coordinator is responsible for oversight...inclusive of the medical necessity/level of care appeals and denials , the length of stay across the continuum; monitoring… more
- Dignity Health (Northridge, CA)
- …than 400 care centers. Visit dignityhealth.org/northridgehospital for more information. Northrdige Hospital Utilization Review RN Utilization Review ... and continued stay authorizations as required within the market. \#LI-DH \#RN \# Utilization Review RN **Responsibilities** + Conducts admission and continued… more
- Prime Healthcare (Philadelphia, PA)
- …track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely with ... these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities The Utilization review tech essentially works to coordinate… more
- 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 integrity of ... Hackensack University Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Behavioral Center of Michigan (Warren, MI)
- …for appeal of denials . Responds to complaints per UR guidelines. Maintains utilization review and appeal logs, as needed. Analyzes patient recrods and ... Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex… 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 ... in such a way that minimizes the risk of denials after discharge. The hours for this position will...documentation from the physician(s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if… 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 ... clinical nursing staff and other departments regarding documentation required for utilization review activities and processes. Collaborate with medical, nursing… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- Summary The Utilization Review Nurse combines clinical expertise with knowledge of medical appropriateness criteria, and applies principles of utilization ... resources as a facilitator and consultant to the multidisciplinary patient care team. The Utilization Review Nurse is responsible for review of clinical… more
- Munson Healthcare (Traverse City, MI)
- …interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic work ... Updates all involved parties regarding potential, threatened or actual denials due to lack of medical necessity or barriers...+ Minimum of three years clinical experience required. Previous utilization review and/or case management in a… more