- 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 ... behaviors to internal leadership for assistance in resolution *Responsibilities:* * Review all inpatient admission and observation cases using InterQual, or Milliman… more
- CVS Health (Phoenix, AZ)
- …+ Clinical experience in ER, ICU, or Critical Care preferred. + Managed Care/ Utilization Management experience. + Experience with Claims Review processes + ... meaningful difference in the lives of patients? Join Mercy Care as a Utilization Management Clinical Consultant and become part of a mission-driven team that's… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …+ Participate in interdisciplinary case rounds, quality improvement initiatives, and utilization review processes. + Support members during transitions of ... health + Experience in a managed care, case management, or utilization review setting + Strong understanding of behavioral health diagnoses, treatments, and… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- …and administering activities related to clinical review , discharge planning, resource utilization , and utilization review . Your primary goal will be ... commitment to teamwork + Experience with InterQual criteria + Understanding of utilization management + Knowledge of CMS regulations + Ability to work autonomously… more
- HCA Healthcare (Kissimmee, FL)
- …and improve the patient flow program effectiveness as it relates to utilization review , resource management, and discharge planning and care coordination. ... the educational leader to physicians and employees as it relates to utilization review , resource management, patient flow, multi-disciplinary rounds and hospital… more
- Trinity Health (Silver Spring, MD)
- …healthcare providers to deliver comprehensive care. + Participate in quality, risk, and utilization review processes. + Supervise and teach residents and other ... Demonstrated experience in the development and management of quality, risk, and utilization review processes. + Strong leadership, communication, and analytical… more
- Sutter Health (San Francisco, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Working ... Center Davies **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the department's accepted… more
- HCA Healthcare (Tallahassee, FL)
- …position if current and compliant** + **Certification in Case Management, Nursing, or Utilization Review , preferred** + **Three years of nursing experience in ... throughput while supporting a balance of optimal care and appropriate resource utilization . The RN CM Care Coordinator will identify potential barriers to patient… more
- Corewell Health (Grand Rapids, MI)
- …of the guiding principles will be demonstrated through applications of evidence-based utilization review process and application of sound clinical judgement. The ... peer clinical discussions, and participation in denials management which include review of previous clinical decisions by Priority Health Medical Directors… more
- McLaren Health Care (Flint, MI)
- …organizational goals. Assumes responsibility for the clinical administrative aspects of utilization review and case management. Integrates medical management ... and procedures as well as documentation of the case management and utilization management processes. Responsible to collaborate in the delivery of the Quality… more