- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Utilization Review /Quality Assurance Coordinator is responsible for all compliance related paperwork and ensures all compliance paperwork is ... completed in a timely manor for the Upstate/Syracuse City School District school-based mental health care program. This position helps ensure successful visits by DNV and OMH when they occur. Monitors and maintains performance improvement indicators on a… more
- Tufts Medicine (Tyngsboro, MA)
- …system tools to resolve accounts, including Patient Access, Revenue Integrity, Coding, Medical Records, Utilization Review , Hospital Departments, Physician's ... eligibility verification, billing edits, claim edits, payer follow-up, correspondence review , corrected claims, appeals, reimbursement verification, and remittance for… more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and ... authorization. This includes approval determinations and appropriate exceptions, coordinating with Medical Directors on denials. In addition, the UR nurse is… more
- Trinity Health (Fort Lauderdale, FL)
- …Care Plans to ensure authorization for hospital stay. Hybrid Position **_Position Purpose:_** ** Utilization Review (UR) Nurses play a vital role in healthcare by ... hospital clinical experience is required.** Recent experience in case management, utilization review , discharge planning, ongoing monitoring and evaluation of… more
- Seattle Children's (Seattle, WA)
- …with medical complexity Current or previous hospital case management or utilization review experience Current or previous case management or utilization ... **Benefits Information** Seattle Children's offers a generous benefit package, including medical , dental, and vision plans, 403(b), life insurance, paid time off,… more
- Prime Healthcare (Ontario, CA)
- …working for a Health Plan. + At least 3 years of experience in utilization review , referrals, authorizations, denials and appeals. + Current BCLS (AHA) ... of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive review of the medical record for the medical necessity,… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Proficient in application of clinical guidelines ... **Responsibilities** Responsible for the review of medical records for appropriate...multiple stakeholders + Professional communication skills. + Understand how utilization management and case management programs integrate. + Ability… more
- Swedish Health Services (Seattle, WA)
- …to be considered_** **Care Manager RN** **Per diem / On call** **Day shift** The Utilization Review (UR) Nurse has a strong clinical background blended with a ... well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program… more
- Henry Ford Health System (Troy, MI)
- …Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. ... Science Nursing required OR four (4) years Case Management/ Appeal/ Utilization Management experience in lieu of bachelor's degree. CERTIFICATIONS/LICENSURES… more
- Henry Ford Health System (Troy, MI)
- The support specialist is a support role crucial to the centralized Utilization Review team for time sensitive authorization tracking and resolution process. ... Additional Information + Organization: Corporate Services + Department: Central Utilization Mgt + Shift: Day Job + Union Code:...Ford is one of the nation's most respected academic medical centers and is leading the Future of Health:… more