- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... Our Team of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager, you will:** + Directs staff performance… 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)
- …just, equitable, and innovative healthcare delivery system. **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
- 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
- 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
- MD Anderson Cancer Center (Houston, TX)
- …appeals to mitigate denials KEY FUNCTIONS Standards of Practice a₠" Utilization Review Concepts Applies approved clinical criteria and payer related ... trainees, professionals, employees and the public. The primary purpose of the Utilization Review Nurse position is to: Evaluate the necessity, appropriateness,… 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 ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… 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
- Dignity Health (Phoenix, AZ)
- … Utilization Management, performing essential duties and responsibilities ( utilization reviews, denials , and authorizations) in non-represented markets, ... of utilization management + Medicare, Medicaid, and commercial admission and review requirements + In-depth knowledge of utilization management processes and… 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
- Henry Ford Health System (Troy, MI)
- Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. ... and medical necessity for intensity of service. 4. Responds to pre-claim payor denials by facilitating peer-to-peer discussions to prevent post-bill denials . 5.… more
- Baptist Memorial (Jackson, MS)
- Overview 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...Communicates with physician advisors related to status concerns or denials + Updates auth/cert screen in the electronic medical… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing team. The UR Specialist ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- BayCare Health System (St. Petersburg, FL)
- …foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions ... the supervisor including but not limited to processing concurrent denials . + Preferred experience includes Critical Care or Emergency...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- BayCare Health System (Clearwater, FL)
- …foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions ... the supervisor including but not limited to processing concurrent denials . + Preferred experience includes Critical Care or Emergency...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- St. Peters Health (Helena, MT)
- The Utilization Management Nurse reports directly to Utilization Review RN Coordinator. The UR Nurse supports the UR RN Coordinator in providing oversight ... and guidance to all utilization functions for the organization and is responsible for...from the ED through discharge and follows and addresses denials to assess effectiveness of documentation and billing practices… more
- Ascension Health (Baltimore, MD)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- HonorHealth (Scottsdale, AZ)
- …communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more