- Beth Israel Lahey Health (Plymouth, MA)
- …management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established guidelines ... using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to… more
- Catholic Health Services (Melville, NY)
- …or regulatory timeframes. Collaborates in clinical discussions with the Catholic Health Physician Advisor when appropriate. Reviews results from managed care ... for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician...and level of care to MCC in response to physician order, or review of updated clinical… more
- Guidehouse (New York, NY)
- …on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis + Performs ... None **What You Will Do** **:** + Performs chart review of identified patients to identify quality, timeliness and...of the relevant guidelines and appropriate referrals to the physician advisor and the UR Committee +… more
- AdventHealth (Tampa, FL)
- …indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated leader for additional review as determined by department ... **le you'll contribute:** The role of the Emergency Department Utilization Management (UM) Registered Nurse (RN) is to use...to ensure timely resolution of issues. Collaborates with the physician and all members of the multidisciplinary team to… more
- AdventHealth (Tampa, FL)
- …indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated leader for additional review as determined by department ... 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. Performs… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Physician Advisor Operations Coordinator, Revenue Integrity and Utilization PRN/OCC, Variable Hours, Day Shift Covenant Health Overview: Covenant ... utilization management functions related to the coordination of physician advisor related activities. Prepares necessary documentation for insurance… more
- AdventHealth (Tampa, FL)
- …indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated leader for additional review as determined by department ... role you'll contribute:** The role of the Emergency Department Utilization Management (UM) Registered Nurse (RN) is to use...of ED nursing experience Preferred + 1 years of Utilization Management experience Preferred This facility is an equal… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …appeal or change in patient class. + Coordinates third party appeals with the physician advisor team when needed. -Uses sound clinical judgement, reasoning, and ... experience required. + Experience - At least 3 years of experience in Utilization Review or Care Management is required or previous appeal experience. + Working… more
- CVS Health (Oklahoma City, OK)
- …with managed care, as a provider and manager of care utilization review or physician advisor experience. * Child/Adolescent Board Certification ... Medical Director (Behavioral Health), you will: * Provide leadership and day-to-day physician oversight for utilization management team, including the management… more
- Veterans Affairs, Veterans Health Administration (Loma Linda, CA)
- …required; Experience supervising physicians and supporting utilization management as a Physician Utilization Management Advisor (PUMA) is preferred; Must ... L. Pettis Memorial Veterans Hospital is recruiting for a Full-Time, Permanent, Physician , Chief of Inpatient Medicine and reports directly to the ED-Inpatient… more
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