- Houston Methodist (Sugar Land, TX)
- …Provides education to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of department scores for ... efficient use of resources and seeks assistance from the Physician Advisor when necessary. Informs management of...state, local, and federal programs + Comprehensive knowledge of utilization management , case management , performance… more
- AdventHealth (Tampa, FL)
- …cancer and other diseases. **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise ... standards. When screening criteria does not align with the physician order or a status conflict is indicated, the...of critical care nursing experience preferred. 1 years of utilization management experience preferred. This facility is… more
- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, ... financial, and utilization goals through effective management , communication, and...actions to UR Committees, as appropriate * Partners with Physician Advisor to engage in second level review and… more
- Guthrie (Troy, PA)
- Up to a $15,000.00 Sign on Bonus! Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other ... physician offices, and the Robert Packer Hospital Business Office,...Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …+ And more **Description** We're seeking under the direction of the ** Utilization Management Appeals Professional, Registered Nurse** is responsible for managing ... + Educates all members of the patient care team, Medical Directors and Utilization Management leadership regarding trends in clinical documentation needs and… more
- Trinity Health (Des Moines, IA)
- …the STAR admitting system. ESSENTIAL FUNCTIONS: + Conducts admission review per the Utilization Management Plan to ensure that the hospitalization is approved ... Mercy West Lakes. Works in collaboration with the attending physician and the Case Management staff utilizing...of the change. + Documents in the Medical Record Utilization Management forms accurately to reflect the… more
- Guthrie (Binghamton, NY)
- …necessary. Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations The pay range for this ... Provides health care services regarding admissions, case management , discharge planning and utilization review....Employer. The Guthrie Clinic is a non-profit, integrated, practicing physician -led organization in the Twin Tiers of New York… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …inpatient, and extended recovery admissions as required based on Emory Healthcare's Utilization Management Plan and the UR Department ?s processes. + ... of Georgia and Federal regulatory requirements as designated in Emory Healthcare's Utilization Management Plan. + Maintains all required annual competencies,… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …inpatient, and extended recovery admissions as required based on Emory Healthcare's Utilization Management Plan and the UR Department processes. 4. Ensures ... of Georgia and Federal regulatory requirements as designated in Emory Healthcare's Utilization Management Plan. 3. Maintains all required annual competencies,… more
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