- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... policies. When necessary, cases are escalated to the Medical Director for further review . The reviewer independently...in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong… more
- LifeCenter Northwest (Bellevue, WA)
- …or operational needs. + Collaborate with the Director , Organ Utilization , to manage departmental budgets and identify cost- management opportunities without ... clinical proficiency and participate in on-call schedule as directed by the Director , Organ Utilization , available for consultation outside of regular working… more
- Saint Francis Health System (OK)
- …is not all inclusive nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location: Virtual Office, Oklahoma ... levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate...participate in treatment teams, Patient Care Committee, and the Utilization Review Staff Committee by providing data… more
- Centene Corporation (New York, NY)
- …license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a… more
- Saint Francis Health System (Tulsa, OK)
- …participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of ... support to the hospital and treatment team throughout the review of patients, their placement in various levels of...nor does it prohibit the assignment of additional duties. Utilization Management - Laureate Campus Location: Tulsa,… more
- South Middlesex Opportunity Council (Framingham, MA)
- …individuals, children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. ... fashion, for the RRS and outpatient clinic programs. + Review denials and partially paid claims and resolve discrepancies....As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or… more
- Integra Partners (Troy, MI)
- … Director ) with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES + ... Monitor incoming faxes + Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS...external sources + Other duties as assigned by UM Director + Strong organizational skills, ability to adapt quickly… more
- University of Utah Health (Salt Lake City, UT)
- …trust that are integral to our mission. EO/AA_ + The Staff Utilization Coordinator is responsible for providing healthcare operational support services, including ... Timekeeping team. + Collaborating closely with Nursing Leadership, the Staff Utilization Coordinator reviews and develops schedules based on agreed-upon staffing… more
- Houston Methodist (Houston, TX)
- …strategic oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is ... At Houston Methodist, the Sr Director Case Management position is responsible...initiatives. + Provides strategic vision and execution for case management and utilization review across… more
- Sharp HealthCare (San Diego, CA)
- …roundsReviews 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 Case Manager Lead, as needed.Keeps SRS… more