- Integra Partners (Troy, MI)
- …as operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director (s), ensures consistent application ... Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director 's responsibilities include but are… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to ... and are committed to consistency, compliance, and evidence-based decision making. The Utilization Review Medical Director 's responsibilities include but… more
- Fallon Health (Worcester, MA)
- …the cost of care opportunities related to Utilization Management. + Works with VP/ Medical Director to set agenda related to UM and represent the plan at ... purpose:** With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief ...for hiring appropriate non-physician clinical and non-clinical personnel to review medical cases and determine if requests… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... Director , Utilization Management + Oakland, CA...reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance… more
- UNC Health Care (Morrisville, NC)
- …People** - Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate and empower ... well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational… more
- Wellpath (Cleveland, OH)
- …training, education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees ... to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... Overview AtCentinela Hospital Medical Center, our dedicated team of professionals are...part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Senior Director of Health Services - Utilization Management Location: Hybrid | ... join us. The Impact You Will Have The Senior Director of Health Services, Utilization Management is...UM/Cost Protection * Accountabilities include the overall value of utilization management (UM) product, medical and reimbursement… more
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... hospital contractual payor agreements. This position reports to the Director of Utilization Management and works with...+ Staff Acquisition and Support: Leads and manages the utilization review staff and function for the… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …professional development specialist to develop standard work and expectations for the utilization review process, including timely medical necessity ... trends for opportunities to improve services. Partners with hospital Director Transitional Care to report avoidable days, trends, and...with payers, as appropriate * May participate in the Utilization Review Committee to present medical… more
- Community Health Systems (Naples, FL)
- …regarding medical necessity and care status. + Proficient in utilization review processes, admission criteria, and payer authorization requirements. + ... Join us as a **Registered Nurse (RN) - Utilization Review position** at Physicians Regional...Student Loan Contribution: Up to $20k Other incentives include: Medical , Vision, Dental, 401k match & more available for… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... improvement in both areas.* Refers cases and issues to Medical Director and Triad Team in compliance...Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... provision of quality based patient care focusing on the medical necessity and efficiency of the delivery of such...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… more
- Behavioral Center of Michigan (Warren, MI)
- Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex ... and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart...all tasks requested by the UR Manager, CEO or Medical Director to meet the needs of… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC - Clear...target. + Presents LOS variances for review to Director and Inpatient Medical Director . Transfer ... or observation in Community Hospitals and UTMB-TDCJ Hospital. + Performs utilization review procedures by prospectively, concurrently, and retrospectively… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and ... secure timely authorizations for hospital admissions and extended stays. The Utilization Review Coordinator monitors and documents all authorization activities,… more
- George C. Grape Community Hospital (Hamburg, IA)
- …Utilization Review Nurse Position Summary: The Quality/ Utilization Review Nurse is responsible for evaluating the medical necessity, appropriateness, ... to infection prevention protocols and regulatory compliance. Key Responsibilities: * Utilization Review : o Conduct concurrent and retrospective reviews of… more
- Martin's Point Health Care (Portland, ME)
- …requests (prior authorization, concurrent review , and retrospective review ) for medical necessity referring to Medical Director as needed for ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible...Utilize evidenced-based criteria, governmental policies, and internal guidelines for medical necessity reviews. + Manage the review … more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more