- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... Analyst works with physicians, the payers and inpatient case management team to validate the medical necessity of the...necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue… more
- UPMC (Bridgeville, PA)
- …coordination of benefits, complaints and grievance guidelines and prescription drug utilization management required + Thorough knowledge in MS Office ... UPMC Rx Partners is looking for a full time Pharmacy Clinical Review Specialist to join their dedicated team! You will oversee administrative and system processes… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …nursing program. Must have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management (UM) experience is preferred. ... Nurse (Non-Practicing) to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions' premier… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years...Review or + Required 2 years in Case Management or + Required 3 years Registered Nurse +… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) Assistant Nurse Manager (ANM) is a Registered Nurse (RN) who assists to control costs for VISN 10 and/or VISN 12 ... of appropriate evidence-based practices for positive outcomes. Responsibilities The Revenue Utilization Review (RUR) Assistant Nurse Manager (ANM) is directly… more
- State of Massachusetts (Boston, MA)
- …staff to ensure compliance with DMH regulations, policies, and procedures, including utilization management reviews, case management documentation, incident ... (HSC) I staff and assigns individuals referred for case management to HSC I staff ensuring the provision of...as needed. . *Staff Supervision and Development:*Assign and regularly review HSC I staff caseloads, provide regular case supervision… more
- US Tech Solutions (Topeka, KS)
- …for Healthcare. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management ... tools and resources. **Responsibilities:** - Through the use of care management tools and information/data review , conducts comprehensive evaluation of referred… more
- Hartford HealthCare (Farmington, CT)
- …CDI subject matter expert guidance to CDS team, coding, physician leadership, quality management , utilization management , all providers, and others as ... now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the… 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....degree such as nursing, social work, psychology, health information management or other related healthcare field is preferred or… more
- CDPHP (Latham, NY)
- …two (2) years experience in a health insurance related discipline required. + Utilization management experience is preferred. + Knowledge of managed care, health ... to logging and routing requests for authorization to the appropriate clinical reviewer . CSS reviews clinical documentation and determines at times what is being… more