- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the...employed physician advisors to support decision-making and adherence to care standards. + On-site Review Preparation: Assists… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager...care determination and the appeal/denial process. + Oversees utilization review workflow processes to ensure timely… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring...**Required Experience (must have):** + 2 to 3 years Utilization Management experience in a managed care … more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... access the full range of their benefits through the utilization review process. + Conducts admission reviews....with medical terminology and in criteria for acute psychiatric care or combination of education and experience preferred. +… more
- State of Indiana (Indianapolis, IN)
- …The role of Utilization Management Manager oversees the integration of utilization review , clinically appropriate care and risk management for the ... Utilization Management Manager Date Posted: Nov...achieve positive health outcomes through access to high quality care and services. You serve as the utilization… more
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/236088/rn-case- manager utilization - ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing… more
- Helio Health Inc. (Syracuse, NY)
- …+ Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care , or managed care setting. ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical necessity and level of ...this position is able to cover a multitude of utilization review functions through point of entry,… more
- Community Health Systems (Franklin, TN)
- …appeals activities, and collaborates with healthcare providers to facilitate efficient patient care . The Clinical Utilization Review Specialist monitors ... 2-4 years of clinical experience in utilization review , case management, or acute care nursing...Compact State Licensure required + CCM - Certified Case Manager preferred or + Accredited Case Manager … more