- The University of Vermont Health Network (Plattsburgh, NY)
- Unit Description: The Utilization Review Team monitors, collects and analyzes data and evaluates variances of resource utilization , complications and overall ... criteria or established practices. Utilizing these skills assists the Medical Center in providing optimal care in a cost...the efficient and effective use of patient services. The Utilization Review Team's role in data collection,… more
- CHRISTUS Health (Alamogordo, NM)
- …status and assists him/her in ensuring proper placement of patient. Conducts utilization review using nationally recognized medical necessity criteria ... and documents the review . Refers cases for second level reviews when medical necessity criteria are not met. Demonstrates familiarity with the various levels of… more
- Marion County (Salem, OR)
- …complex needs, many of whom also have co-occurring substance use disorders and medical conditions. You would have the opportunity to build strong relationships while ... complex needs, many of whom also have co-occurring substance use disorders and medical conditions. This position is an outward facing position, operates on a systems… more
- Saint Francis Health System (Tulsa, OK)
- …of adverse physiological trends, assurance of appropriate prophylactic strategies, and medical chart review . Virtually evaluates patients, educates the patient ... an on-site office location (not a remote position)Will perform admit, discharge chart review and other patient care duties from an office location via secure virtual… more
- Elevance Health (Columbus, OH)
- …+ Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate on committees or in ... **Clinical Operations Medical Director** ** Utilization Management of ...Perform physician-level case review , following initial nurse review , of Medical Oncology regimens and supportive… more
- Martin's Point Health Care (Portland, ME)
- …to support accurate medical necessity and dispute decisions. + Partners with Medical Directors, Utilization Review Team, Provider Inquiry, and Claims ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member... outcomes. Job Description Key Outcomes/Results: + Manages the review of medical claims disputes, records, and… more
- Beth Israel Lahey Health (Burlington, MA)
- … necessity recommendations, as requested Policy Setting Responsibilities Responsible for utilization review and medical necessity recommendations, as ... compliance with responsibilities. Supervisory Responsibility: Responsible for engaging physicians in utilization review and medical necessity activities Key… more
- Spectrum Billing Solutions (Skokie, IL)
- …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing...+ Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment. +… more
- St. Luke's University Health Network (Allentown, PA)
- …incorrect registrations and/or physician queries + Serves as liaison between Physician Advisor/ Medical Director, Finance, Utilization Review Department and ... Conducts reviews of cases lost with feedback to respective departments + Conduct concurrent review with utilization review department for post op surgical… more
- Intermountain Health (Las Vegas, NV)
- …by UM Medical and Operational Leadership. Job Profile: + Trains and educates on medical review activities pertaining to utilization review , claims ... review , quality assurance, and medical review of complex, controversial, or experimental medical ...criteria, and state, local, or federal guidelines relating to utilization management. + Demonstrated knowledge of case management, … more
- Serco (Washington, DC)
- …surgical claims from a variety of provider types; + Extensive experience performing medical review and/or utilization /QA reviews; + Education, Licensure, and ... **Position Description** Serco is seekinga motivated Medical Review Subject Matter Expert to...a supervisory/managerial role in the health insurance industry, a utilization review firm, or another health care… more
- Beth Israel Lahey Health (Burlington, MA)
- … and hospital staffs. -Case Manager experience as well as Utilization Review experience ( review medical necessity and discharge planning) **FLSA ... States of America) Joint role of Case Manager and Utilization Review Nurse Hospital at Home Full...post acute care Services. 15) Participates in hospital or medical committees representing patient issues and department functions such… more
- The Cigna Group (Bloomfield, CT)
- …not be included in CMS' Preclusion List** **Preferred Skill Sets:** + Experience in medical management, utilization review and case management in a managed ... level case work for Cigna Medicare. **Summary description of position** : A Medical Principal performs medical review and case management activities.… more
- Elevance Health (Miami, FL)
- …care industry strongly preferred** . + 2 years of experience in In-Patient, utilization review / management, evaluating medical necessity for services ... Senior RN Utilization Review /Management (Acute InPatient) JR116937 **Location:**...**2 Holidays** per year and **occasional** weekends. The **Nurse Medical Management Sr** serves as **team lead** for nursing… more
- Providence (Portland, OR)
- …experience in an acute adult medical /surgical care setting, OR Current Utilization Review or Case Management experience. + Demonstrated clinical expertise ... NM or TX are encouraged to apply** The RN Coordinator- Utilization Review supports the care of the...the urban setting of Portland. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer,… more
- Lancaster General Health (Lancaster, PA)
- …to clinical services provided by the Hospitalists, quality improvement, education of staff, medical and utilization review and feedback, and support for ... **Summary** **Job Description** **POSITION SUMMARY:** The Associate Medical Director, Hospitalist Services is responsible for assisting the Medical Director,… more
- US Tech Solutions (Columbia, SC)
- …School of Nursing. Required Work Experience: 2 years clinical experience plus 1 year utilization / medical review , quality assurance, or home health, OR, 3 ... PALMETTO GBA (CO. 033) ONLY: 2 years clinical experience plus 2 years utilization / medical review , quality assurance, or home health experience or a… more
- Nuvance Health (Danbury, CT)
- …The Physician Advisor will develop and maintain expertise in assessing inpatient medical necessity, utilization review and assignment of appropriate ... medical providers, case managers, and other staff regarding appropriate utilization review processes, correct status assignment, and necessary clinical… more
- The Cigna Group (Bloomfield, CT)
- … utilization and financial initiatives. Responsible for program execution and drives utilization review medical program management for specific clinical ... Description SummaryGuides the company on strategic Utilization Review decisions and provides medical advice that... Utilization Review decisions and provides medical advice that has a significant impact on strategic… more
- SUNY Upstate Medical University (Syracuse, NY)
- …patients, maintaining accurate attendance and therapy records. Interfaces with nursing, medical staff, utilization review social services, discharge ... progress through written and verbal reports and through documentation in the medical record. Plan and schedule patient therapy based on individual needs. Schedules… more
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