- Dignity Health (Rancho Cordova, CA)
- …services using clinical judgment and established guidelines. Refer to Medical Directors for review depending on case findings. - Collaborate with various staff ... - Three (3) years acute care or related experience, including experience in case management, utilization review or discharge planning. - Clear and current… more
- Behavioral Center of Michigan (Warren, MI)
- Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex ... data and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart and records clinical information and… more
- Beth Israel Lahey Health (Burlington, MA)
- …8-hour shifts. The Utilization Analyst works with physicians, the payers and inpatient case management team to validate the medical necessity of the hospital care. ... Using the concepts of utilization review , clinical documentation improvement and revenue..., clinical documentation improvement and revenue integrity, these specialized case managers analyze medical documentation to ensure that proper… more
- Baylor Scott & White Health (Dallas, TX)
- …vary based on position type and/or level **Job Summary** + You will review patient cases for medical necessity and establish service suitability. You'll educate the ... plan and the provider's care coordination departments. Your expertise is needed to review medical necessity. + Working with the team, you'll verify medical records… more
- Beth Israel Lahey Health (Boston, MA)
- …Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on ... of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for… more
- Zurich NA (Schaumburg, IL)
- …terminology Preferred Qualifications: + 2 or more years' experience in Utilization Review , Case Management, Workers Compensation, or medical bill reviews + ... Medical Bill Review Senior Nurse 127127 Zurich Insurance is currently looking for a **Medical Bill Review Senior Nurse** to work from our Schaumburg, IL office.… more
- BAYADA Home Health Care (Austin, TX)
- …around this requirement.** BAYADA Home Health Care is hiring a full time OASIS Review and Coding Manager. The OASIS and Coding Review Manager provides support ... quality and adherence to policies and procedures. As a member of the Medicare Case Management (MCM) office, individuals in this role are expected to maintain ongoing… more
- Children's Mercy Kansas City (Kansas City, MO)
- …children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based guidelines, insurance ... 60 days of hire + One of the following: American Case Management Certification or Certified Case Manager + Employees must obtain Certified Case Manager… more
- Prime Healthcare (North Las Vegas, NV)
- …follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review ... more. For more information, please visitwww.northvistahospital.com. Responsibilities The Utilization review tech essentially works to coordinate the utilization … more
- Molina Healthcare (Warren, MI)
- …set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, ... responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and… more