- Saint Francis Health System (Tulsa, OK)
- …participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of ... support to the hospital and treatment team throughout the review of patients, their placement in various levels of...and benefits of patients, matching the level of care utilization . Assures compliance with Managed Care Behavioral Health standards… more
- Albany Medical Center (Albany, NY)
- …Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to monitor appropriateness of admissions… more
- Wellpath (Freehold, NJ)
- …point of care support. **About this role** The Medical Director of Utilization Management leads and oversees utilization review , case management , ... appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and stakeholders,… more
- US Tech Solutions (Columbia, SC)
- …established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- BriteLife Recovery (Englewood, NJ)
- …assigned What we need from you? + Minimum of 2-3 years of experience in utilization review , case management , or insurance coordination in a behavioral health ... What you will be doing? The Utilization Review (UR) Specialist is a...Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in… more
- Cedars-Sinai (Los Angeles, CA)
- …more about you and your skills! **What will you be doing in this role?** The Utilization Review Case Manager validates the patient's placement to be at the most ... Manager follows the UR process as defined in the Utilization Review Plan in accordance with the...- PER DIEM - 8 Hour Days **Department** : Utilization Management **Business Entity** : Cedars-Sinai Medical… more
- Providence (Irvine, CA)
- **Description** **RN Utilization Review at Irvine, CA. This position is Full- time and will work Remote 8-hour, Day shifts.** Provide prospective, retrospective, ... strong clinical background combined with well-developed knowledge and skills in Utilization Management , medical necessity, and patient status determination. The… more
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review - Remote. This position will work full- time in a 8-hr Day shift.** Provide prospective, retrospective, and concurrent ... strong clinical background combined with well-developed knowledge and skills in Utilization Management , medical necessity, and patient status determination. The… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt of high ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental...preferably in a hospital setting + 2+ years of utilization management experience in a health plan… more
- UNC Health Care (Hendersonville, NC)
- … reviews in accordance with federal regulations and the health system's Utilization Review Plan. Responsibilities: + Uses approved criteria and conducts ... management referrals. Initiates appropriate social work referrals. + Performs utilization management assessments and interventions, using collaboration with… more