- 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
- HonorHealth (Scottsdale, AZ)
- …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… 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
- BayCare Health System (St. Petersburg, FL)
- …a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + ... St Petersburg, FL + **Status:** Full Time: 72 hours per every two weeks + **Schedule:** Week 1: 5...Community discounts and more Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review Specialist Senior **Location**… 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
- Truman Medical Centers (Kansas City, MO)
- …into myWORKDAY (http://www.myworkday.com/trumed/d/home.htmld) to search for positions and apply.** Utilization Specialist 101 Truman Medical Center **Job ... Type** Full time **Work Schedule** 8:00AM - 4:30PM **Hours Per Week** 40 If you want to work where...coaching and consulting to outside organizations. **Job Description** The Utilization Specialist will verify all financial and… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Amergis (Middletown, CT)
- The Utilization Review Specialist is...or chest x-ray if applicable + Current Health certificate ( per contract or state regulation) + Must meet all ... + A Bachelor's Degree in Nursing or at least two years' experience in Utilization Review preferred + Certification in Utilization Review or … more
- Katmai (Usaf Academy, CO)
- …for inpatient/outpatient precertification. **ESSENTIAL DUTIES &** **RESPONSIBILITIES** + Review precertification requests for medical necessity, referring to the ... Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part...Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,… more
- MyFlorida (Tallahassee, FL)
- OPERATIONS REVIEW SPECIALIST - 60020714 - ESS...policy. This is a full-time position working 40 hours per week. Business hours of operation are 8:00 AM ... No: 848234 Agency: Children and Families Working Title: OPERATIONS REVIEW SPECIALIST - 60020714 - ESS Pay...related duties as assigned. KNOWLEDGE, SKILLS AND ABILITIES, INCLUDING UTILIZATION OF EQUIPMENT, REQUIRED FOR THE POSITION: + Knowledge… more
- Stony Brook University (Stony Brook, NY)
- Per Diem - Behavioral Health Specialist **Position Summary** At Stony Brook Medicine, our Behavioral Health Specialist : + Orients patients to treatment ... interventions, restraint/seclusion, behavior plan development and safety plan development, utilization and monitoring. + Conducts a variety of patient treatment… more
- Trinity Health (Troy, NY)
- …that result from the clinical utilization reviews with the facilities Per Diem- Insurance Specialist to assist with authorizations for Substance abuse ... college level course in medical terminology. + One year of case management or utilization review /billing or coding experience. + One year of experience in… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... experimental, coding or other issues that may require record review . Provides billing with information needed to obtain payment...SENSORY REQUIREMENTS: Requires sitting for up to 4 hours per day, 2 hours at a time. Standing for… more
- New York State Civil Service (Albany, NY)
- …Compliance Analyst 1, Standards Compliance Analyst 1 (Developmental Disabilities), or Utilization Review Coordinator.If you are appointed provisionally, you must ... Analyst 1, Standards Compliance Analyst 1 (Developmental Disabilities), or Utilization Review Coordinator. PREFERRED QUALIFICATIONS:* Experience in bookkeeping,… more
- St. Luke's University Health Network (Bethlehem, PA)
- …patient's ability to pay for health care. The Diagnosis and OASIS Specialist is responsible for coding pertinent medical information on patient classifications ... Consistently meets established productivity targets for coding assignment and record review . + Communicates and collaborates with Quality Managers, Patient Care… more
- MyFlorida (Fort Myers, FL)
- …provisions of Chapter 60L-36, Florida Administrative Code. OSTDS Program: The environmental specialist is expected to review residential applications and plans, ... ENVIRONMENTAL SPECIALIST II - 64005698 Date: Mar 17, 2025...for performing assigned program state inspections at least once per year and starting enforcement of in instances of… more
- CaroMont Health (Gastonia, NC)
- …factual arguments to recoup revenue. This position also facilitates collaboration between the Utilization Review Specialist 's, Coding staff, HIM staff, CDI ... and Denial Specialist will work collaboratively with Health Information Management, Utilization Review and Clinical Documentation Specialist to mitigate… more
- Dartmouth Health (Lebanon, NH)
- …capacity analysis. * Analyzes inventory/product data, utilizing customized query utilization reports and formulates recommendations for adjustments as necessary to ... and positive financial outcomes * Meets with department managers or directors to review PAR statistical data and makes recommendations for adjustments which meet the… more
- Veterans Affairs, Veterans Health Administration (Fayetteville, NC)
- …severity of illness, risk of mortality, complexity of care, and utilization of resources. Identifies opportunities for documentation improvement by ensuring that ... and completeness of clinical documentation. Inpatient CDI focuses on the concurrent review of patient records with an emphasis on improving documentation while the… more
- Oregon State University (Salem, OR)
- …Position Information Department Ext Computer Svc Admin (TEX) Position Title Specialist 2-Instructional Job Title Technology in Natural Resources Specialist ... of Extension and Engagement is seeking a Technology in Natural Resources Specialist . This is a full-time (1.00 FTE ), 12-month, professional faculty position.… more