- Insight Global (Brea, CA)
- Job Description Insight Global is looking for a UM coordinator to work for a large health services company. This person will be responsible for processing ... to determine if submitted requests are in scope for review and then redirect as required. They will be...and Requirements - 1-3 years of experience as a UM coordinator -- specifically requesting or submitting… more
- Universal Health Services (Chicago, IL)
- …, External Independent Reviews, Retrospective Reviews, and State Fair Hearings. Review clinical information for all appeals utilizing nationally recognized ... of services requested. Prepare letters for member and provider appeals that did not meet criteria. Gather, analyze, and...and retrospective reviews through resolutions. Remain current on applicable UM trends and regulations and review current… more
- Ellis Medicine (Schenectady, NY)
- …the chart to fax or send for insurance denials or quality improvement organization appeals . + Assists UM Coordinator with data entry of insurance ... confidential information per policy. + Assists Utilization Management with initial clinical review requests as needed. + Notifies Case Manager of any potential… more
- Universal Health Services (Doylestown, PA)
- Responsibilities Foundations Behavioral Health is currently hiring a full-time Utilization Review Coordinator to support our UM Department in Doylestown, PA. ... Disorders or other developmental disorders. Position Responsibilities: + The Utilization Review Coordinator provides support to the program and treatment… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient ... approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital… more
- Corewell Health (Wayne, MI)
- …Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. Responsible for managing ... for patients utilizing hospital outpatient, observation or inpatient services. 4. May review cases for medical necessity, uses InterQual and/or other UR/ UM … more
- Corewell Health (Farmington Hills, MI)
- …+ Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). + Responsible for managing ... for patients utilizing hospital outpatient, observation or inpatient services. + May review cases for medical necessity, uses InterQual and/or other UR/ UM … more
- Sharp HealthCare (San Diego, CA)
- …Reviews every patient under assigned workload initially and reviews based on review of care plan.Makes rounds and sees every patient identified per departmental ... guidelines during hospital stay beginning with the admission review of the case manager and reviews with the...to acute or visit to the Emergency Department.Informs Director, QI/ UM of any quality issues.Attends hospitalists rounds, as required,… more
- Universal Health Services (Bloomington, IN)
- Responsibilities The Utilization Management Specialist is responsible for executing the UM function, which includes the implementation of case management scenarios, ... Assures that good customer service practices are utilized. Maintains denials and appeals in Midas and reviews the progress of all appeal activity. Qualifications… more
- UCLA Health (Los Angeles, CA)
- …point of contact for receiving and resolving member denials. You will review denials for accuracy, confirming the receipt of necessary documentation to support ... federal laws/regulations. You will extrapolate and summarize essential information for the UM Manager and Medical Director and regularly meet with them for clinical… more
- St. Bernard's Medical Center (Jonesboro, AR)
- …the reimbursement and denial process. Works with infusion center to prevent denials. Assists UM Coordinator with denials and appeals . Close out each tracked ... and denials information according to discrete outpatient denial codes. Will review for medical necessity. Analyze information related to infusion denials and… more