- Beth Israel Lahey Health (Plymouth, MA)
- …trends/root causes of denials for discussion with the internal team, physician advisor and the Utilization Review Committee as appropriate. + Participate ... you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We Are:** At… more
- Beth Israel Lahey Health (Plymouth, MA)
- …management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established guidelines ... using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to… more
- Brockton Hospital (Brockton, MA)
- …, denials, appeals and reconsideration hearings. Works closely with the physician advisor to proactively intervene in cases where utilization of resources is ... delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare… more
- Beth Israel Lahey Health (Plymouth, MA)
- …and reimbursement. Refers inappropriate observation or anticipated admission cases to the Physician Advisor . Provides real time interventions to prevent delays ... 3) Decreasing unit cost, 4) reducing readmissions. **Duties/Responsibilities:** **A. Utilization Management** Performs review of anticipated admissions utilizing… more
- Fresenius Medical Center (Fairhaven, MA)
- …departments and external customers; particularly in problem resolution. Acts as an advisor to subordinate(s) to meet schedules and/or resolve technical problems. + ... staff in problem solving. **PHYSICIANS:** + Facilitates the application process for physician privileges and compliance with FMS Medical Staff By-Laws. + Responsible… more
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