- Dignity Health (Carmichael, CA)
- …of utilization review , hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria ... **Responsibilities** **Day Per Diem Utilization Review Registered Nurse - Onsite Campus Position** The...on concurrent denials based on payer timeframes. + Coordinates Peer to Peer between hospital provider and… more
- AdventHealth (Glendale Heights, IL)
- …assure resolution of pending denials, which have been referred to the physician for peer -to- peer review with the Medical Director of the insurance carrier. ... for escalation to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM RN is responsible… more
- State of Connecticut, Department of Administrative Services (New Haven, CT)
- …types of case reviews for quality and appropriate medical management, cost containment, peer review and rehabilitation; + Summarizes and analyzes data; + ... Utilization Review Nurse (40 Hour) Office/On-Site Recruitment # 250715-5612FP-001 Location New Haven, CT Date Opened 7/22/2025 12:00:00 AM Salary $78,480 -… more
- Commonwealth Care Alliance (Boston, MA)
- …for performing daily medical reviews, appeals as appropriate, correspondence regarding review determinations and physician peer review activities. ... Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for… more
- Spectrum Billing Solutions (Skokie, IL)
- …authorization for treatment services. + Manage authorization denials including referral for peer review . + Demonstrate the ability to make critical decisions ... healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team. The Utilization ...Review Specialist to our growing team. The Utilization Review Specialist will utilize his or her knowledge and… more
- Bozeman Health (Bozeman, MT)
- …management of the credentialing life cycle and a robust, fair, and timely peer review program. Qualifications: Required: + Bachelor's Degree in healthcare ... hire. + Three (3) years of progressive responsibility in medical staff services, peer review processes, credentialing, and credential verifications. + Two (2)… more
- AdventHealth (Calhoun, GA)
- …iConnect. + Serve as champion and liaison for all aspects of the compliant documentation program. Peer Review : + The CMO shall support the peer review ... and/or the medical staff by performing the following: + Attend the Peer Review meetings conducted on a scheduled basis by the Director, Quality Management.… more
- HCA Healthcare (Manchester, NH)
- …of any upcoming or ongoing surveys relative to credentialing, privileging and PPE/ peer review activities and functions. Coordinate accreditation, regulatory, and ... any internal surveys relative to credentialing, privileging and PPE/ peer review activities and functions. Respond to any reviews accreditation and regulatory… more
- LifePoint Health (Beckley, WV)
- …and Ongoing Professional Practice Evaluation (OPPE) programs as well as coordinating the Peer Review Program in accordance with the medical staff bylaws at ... communication. Responsible for managing the Clinical Professional Practice Evaluation (PPE) or Peer Review . Advance the Medical Staff peer review process… more
- Houston Methodist (Houston, TX)
- …appropriate cases to the Physician Advisor (or services) for appropriate second level review , peer - peer discussions, and payer denial- appeal needs. Consults ... At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered...towards improvement of department scores for employee engagement, ie peer -to- peer accountability. **SERVICE ESSENTIAL FUNCTIONS** + Pro-actively… more
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