- The County of Los Angeles (Los Angeles, CA)
- …Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician member of the ... UTILIZATION REVIEW NURSE SUPERVISOR II Print...by subordinate supervisors on number and status of reviews, physician advisor referrals, and type of … more
- AdventHealth (Glendale Heights, IL)
- …indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated leader for additional review as determined by department ... of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines,...otherwise unresolved status conflicts appropriately and timely to the physician advisor to avoid concurrent denials. +… more
- Houston Methodist (Houston, TX)
- …clinical protocols. + Escalates appropriate cases to the Physician Advisor (or services) for appropriate second level review , peer-peer discussions, ... At Houston Methodist, the Utilization Review Nurse (URN) position is...and payer denial- appeal needs. Consults with physician advisor as necessary to resolve progression-of-care… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... this position is able to cover a multitude of utilization review functions through point of entry,...efficient use of resources and seeks assistance from the Physician Advisor when necessary. Informs management of… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …trends, and actions to UR Committees, as appropriate * Partners with Physician Advisor to engage in second level review and working with attending physicians ... *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional Care Team.Thisis a full-time role. *Purpose of this position:… more
- Alameda Health System (Oakland, CA)
- …placement (eg, inpatient, observation, outpatient). 3. Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may ... System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Evening +… more
- Nuvance Health (Danbury, CT)
- …to department leadership.* 12) Forwards reviews that require secondary physician review to appropriate resource ( Physician Advisor ) 13) Coordinates with ... one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the physician...required. Education: ASSOCIATE'S LVL DGRE Required: 3 Years of Utilization Review experience(or a certification ACMA, MCG,… more
- Covenant Health (Nashua, NH)
- …established UM processes for patients not meeting criteria by utilizing second level review / Physician Advisor services. + Identifies opportunities for ... health care team. + Annual goals are achieved. + Attends pertinent case management/ utilization review programs to maintain current knowledge of UR practices. +… more
- Trinity Health (Fort Lauderdale, FL)
- …Reviewer for Observation services. * Maintains a working relationship with onsite Physician Advisor * Educates Observation Case Managers, including week-end ... Care Plans to ensure authorization for hospital stay. Hybrid Position **_Position Purpose:_** ** Utilization Review (UR) Nurses play a vital role in healthcare by… more
- Hunterdon Health Care System (Flemington, NJ)
- Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure the effective and efficient use ... utilization activities, using Milliman Care Guidelines under the guidance of the Physician Advisor , to provide clinical information to payors as requested and… more
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