- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you...strategy in response to reimbursement denials. + Responsible for appeals and follow up on clinical denials escalated through… more
- Children's Mercy Kansas City (Kansas City, MO)
- …and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient statusing ... functions utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and hospital performance improvement… more
- Mount Sinai Health System (New York, NY)
- …as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...+ Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... access the full range of their benefits through the utilization review process. + Conducts admission reviews. + Conducts...concurrent and extended stay reviews. + Prepares and submits appeals to third party payors. + Maintains appropriate records… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... ensure compliance with utilization management policies. This role conducts admission and continued...conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
- University of Utah Health (Salt Lake City, UT)
- …advancement, and overall patient outcomes. **Responsibilities** + Applies approved utilization criteria to monitor appropriateness of admissions with associated ... or third-party payer. + Alerts and discusses with physician/provider and case manager /discharge planner when patient no longer meets medical necessity criteria for… more
- Molina Healthcare (Everett, WA)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
- Saint Francis Health System (Tulsa, OK)
- …in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal ... the Process Improvement/Quality Director, to appropriate clinicians and to the UM Manager . Reviews eligibility and benefits of patients, matching the level of care… more
- Beth Israel Lahey Health (Plymouth, MA)
- …multidisciplinary team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Corewell Health (Grand Rapids, MI)
- …admission waiting list, insurance prior authorizations, continuous stay reviews and appeals . Additional support to the UM functions of the Corewell Health ... Cross Ambulatory Care Management Upon Hire required + Case Manager , Certified (CCM) - CCMC Commission for Case ...Manager , Certified (CCM) - CCMC Commission for Case Manager Certification Upon Hire preferred How Corewell Health cares… more
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