- Ventura County (Ventura, CA)
- …+ Experience with managed care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs + At ... with managed care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs + Direct patient… more
- Virginia Mason Franciscan Health (Burien, WA)
- …medical staff and take on the role as leader of the Hospital's utilization review /management committee, which is charged with adhering to regulatory requirements ... as needed * Reviews medical records of patients identified by case managers/ utilization review nurses, or as requested by other members of the healthcare team,… more
- Catholic Health Initiatives (Lexington, KY)
- …training sessions. + Participates in the Case Management Process including Utilization Review and Proactive Discharge Planning. Articulates case management ... availability for rounds and / or other daily case management and utilization review activities. Ensures that physicians covering the PA are familiar with the… more
- Brockton Hospital (Brockton, MA)
- …delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare ... management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience required.… more
- Corewell Health (Dearborn, MI)
- …patients. + Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). + ... years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + Registered… more
- Covenant Health Inc. (Knoxville, TN)
- …and financial data to various audiences as necessary. + Completes daily work lists for utilization review meeting the time frames set forth by Covenant Health. + ... Responsibilities + Reviews providers' requests for services and coordinates utilization management review . + Reviews precertification requests for… more
- Houston Methodist (Sugar Land, TX)
- …the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Corewell Health (Royal Oak, MI)
- …patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. ... years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + Registered… more
- Penn Medicine (Philadelphia, PA)
- …the hospital through teaching, consulting, and advising the care management and utilization review departments and the hospital leadership. The Physician Advisor ... changes in payer rules including CMS rules as it pertains to utilization review * Recommend and request additional and more complete medical record documentation… more
- Hartford HealthCare (Manchester, CT)
- …Region serves a region of 300,000 people in 19 towns. POSITION SUMMARY: The Utilization Review Case Manager (UR CM) works in collaboration with the physician ... of care in the acute-care setting. * Minimum of 1 year Utilization Review experience preferred via industry clinical standards, ie, InterQual, Milliman Care… more