- Albany Medical Center (Albany, NY)
- …and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and contacts ... assigned patients.* Discusses payor criteria and issues and a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed.* Uses… more
- Fresenius Medical Center (Fayetteville, NC)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Blue KC (MO)
- …discount program** **Job Description Summary:** Presents data-driven insights and clinical health information to large self-funded client groups and insurance ... and regularly attends client meetings (with benefits managers and executives) to review health outcomes and cost information. + Actively monitors care management… more
- Dignity Health (Long Beach, CA)
- **Job Summary and Responsibilities** As a Clinical Nurse Specialist, you will be a central figure in our patient care team, delivering exceptional, compassionate ... To be successful in this role, you will combine robust clinical knowledge and technological proficiency with genuine compassion, strong communication skills,… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- Stony Brook University (Stony Brook, NY)
- …of clinical experience working as a Physician Assistant or Nurse Practitioner. Previous experience working in gastroenterology, internal medicine, or general ... Physician Assistants. **_Nurse Practitioner:_** NYS license and certification as a Nurse Practitioner. Master's degree (foreign equivalent or higher) in nursing or… more
- BAYADA Home Health Care (Wilmington, MA)
- …DCO to ensure cohesive and consistent management of all field staff. + Review all clinical documentation to ensure consistent, accurate, high-quality services. + ... BAYADA Home Health Care is seeking a Registered Nurse (RN) to fill the position of **Home... (RN) to fill the position of **Home Health Nurse Manager** for our **Wilmington, MA** Medicare Certified home… more
- Huron Consulting Group (Chicago, IL)
- …Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new ... partnerships, clinical services and technology is not enough to create...planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the Utilization… more
- Dignity Health (Chandler, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of ... with applicable standards and regulations and provide information and education to clinical care providers in order to achieve optimal clinical , financial,… more
- Dignity Health (Gilbert, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of ... with applicable standards and regulations and provide information and education to clinical care providers in order to achieve optimal clinical , financial,… more