- Dignity Health (Glendale, CA)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to...multiple stakeholders + Professional communication skills. + Understand how utilization management and case management … more
- SUNY Upstate Medical University (Syracuse, NY)
- …Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, experience with ... with reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria to ensure patients are at the… more
- CVS Health (Madison, WI)
- … Organization a Plus **Preferred Qualifications:** -Preferred Oklahoma residency -Health plan/payor Utilization Management / Review experience. -Managed Care ... the Aetna Better Health Plan of Oklahoma. This UM ( Utilization Management ) Medical Director will be a...Management , including prior authorization as well as concurrent review . Cases could focus on inpatient or outpatient services,… more
- Evolent (Lansing, MI)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- Ascension Health (Jacksonville, FL)
- …of recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to join a ... of care and length of stay determination. + Assist and manage the denial management process. + Review and offer suggestions related to resources and service… more
- UnityPoint Health (Des Moines, IA)
- …to plan and execute a safe discharge + Collaborate with Utilization Management team on continued stay review . + Collaborates with patients, caregivers, ... continuity through elimination of fragmentation of care/service and facilitates the effective utilization of resources. Serves as educator and a central source of… more
- HCA Healthcare (Sun City Center, FL)
- …Healthcare Quality) OR CHCQM (Diploma in American Board of Quality Assurance and Utilization Review Physicians). _Individuals without CPHQ or_ CHCQM _will be ... of experience in a healthcare environment + Previous experience in accreditation, quality, utilization management , or risk management required. + Knowledge… more
- Geisinger (Lewistown, PA)
- …and efficiency results for assigned population. + Works to appropriately apply benefits and utilization management serving as a resource to the patient or member ... as part of a shared rotation. Don't worry, we'll review this in your interview. At least two (2)...have prior RN experience in a hospital setting. Case Management experience is preferred and not required. The successful… more
- Nuvance Health (Danbury, CT)
- …the time of review . If unable to resolve, escalate to the PA and Utilization Review (UR) Leadership. * Coordinate with the care team in changing patient ... in Milliman and InterQual Guidelines required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum of 4… more
- Ochsner Health (Slidell, LA)
- …operative, and postoperative data components for the Program through the effective utilization of the hospital medical record systems. + Responsible for the accurate ... Medical Records, and Information Systems Departments whose support is necessary for the management and success of the Program. + Adapts behavior to the specific… more