- Henry Ford Health System (Troy, MI)
- The support specialist is a support role crucial to the centralized Utilization Review team for time sensitive authorization tracking and resolution ... Additional Information + Organization: Corporate Services + Department: Central Utilization Mgt + Shift: Day Job + Union Code:...team members is our priority. That's why we offer support in the various components of our team's well-being:… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is ... responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD)… more
- BayCare Health System (Clearwater, FL)
- …day per week in office Equal Opportunity Employer Veterans/Disabled **Position** Intake Specialist Utilization Review - Health Plan **Location** ... services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote...the necessary information is gathered for timely and accurate utilization review and that requests for care… 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 Advisors. + Qualifications: A. Education: Holds a current Texas license as a Registered Nurse OR a current Texas Licensed Vocational Nurse. B. Training 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: ... County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose....net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,… more
- Penn Medicine (Lancaster, PA)
- …Medicine Lancaster General Health is looking for an experienced RN to join our Utilization Management Specialist team! In this critical role, you'll advocate for ... thrive under pressure, we'd love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible for evaluating medical… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
- St. Peters Health (Helena, MT)
- The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN supports the UR RN Coordinator and other UR team members in ... providing all identified utilization review functions for the organization to...14. Collaborates with admitting physician, ED physicians, Hospitalists, Documentation Specialist , and other ancillary staff to assist with the… more
- UnityPoint Health (Cedar Rapids, IA)
- …174223 Overview This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments ... care, optimal clinical outcomes and patient and provider satisfaction. The UM Specialist provides the Utilization Management function for patients admitted to… more
- Community Health Systems (Franklin, TN)
- …to secure timely authorizations and reduce potential denials, utilizing input from the Utilization Review Clinical Specialist . + Monitors and updates case ... **Job Summary** The Utilization Review Coordinator ensures efficient and...documentation and process adherence. + Ability to train and support team members, fostering a collaborative and productive environment.… more
- BayCare Health System (Tampa, FL)
- …a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + ... services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- UNC Health Care (Kinston, NC)
- … the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established ... dollars and appeal win rates. 12. Assists in documentation review in the clinical documentation specialist role...experience as a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
- PeaceHealth (Bellingham, WA)
- …of psychiatric diagnostics. + Preferred: Third party reimbursement knowledge. + Preferred: Utilization Review experience, someone who can talk to providers. ... **Description** PeaceHealth is seeking a RN Admissions/ Utilization Behavioral Health - Care Management for a...and follow-up on payer authorization. + Complete UR Admission review and Concurrent review processes. Ensure best… more
- Katmai (Fort Carson, CO)
- …need 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 of the UMRN program, conduct ongoing… more
- SUNY Upstate Medical University (Syracuse, NY)
- …including PC, Windows, Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, ... Job Summary: The UR-CR Specialist I is primarily responsible for ensuring that...reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria… more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan is looking for Pharmacy Clinical Review Specialist I positions in the Pharmacy Services department. This is a full time position working Monday ... through Friday 11:30am to 8:00pm and weekend rotations. The Clinical Review Specialist will oversee administrative and system processes that relate to pharmacy… more
- UPMC (Bridgeville, PA)
- UPMC Rx Partners is looking for a full time Pharmacy Clinical Review Specialist to join their dedicated team! This position provides prescription data entry and ... Rx Partners Skilled nursing and Hospice clients. The clinical review specialist at Rx Partners works hand...Interface with other departments and identify medical documentation in support of prior authorization requests. + Act as a… more
- University of Colorado (Aurora, CO)
- **Temporary GME Software Support Specialist ** **Description** **University of Colorado Anschutz Medical Campus** **Department:** **Office of Medical Education | ... Graduate Medical Education** **Job Title: Temporary** **GME Software Support Specialist ** **This is a Temporary position limited to no more than 9-months** **Job… more
- Immigration and Customs Enforcement (Washington, DC)
- …the IHSC Nursing Services Unit team, they will assist with participating in the development/ review of: i. Special projects to support the DAD of Clinical ... the IHSC Medical Quality Management Unit. SUPERVISORY CONTROLS: The Clinical Senior Nurse Specialist , Medical Asset Support Team (MAST) member works under the… more
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