- University of Maryland, Baltimore (Baltimore, MD)
- …related to the delivery of medical care and clinical services such utilization review , quality assurance, policies, procedures and guidelines development. 3. ... documentation to support clinical and reimbursement activity. 7. Participates in the Peer Review Program as described in the Medical Staff Bylaws and policies as… more
- Baystate Health (Springfield, MA)
- …preferred + Requires a working knowledge of community resources and Utilization /Quality Review standards. Understanding of the hospitals patient placement ... on admission to identify level of care, potential need for practice guideline utilization , to determine the anticipated LOS and anticipated care needed for each… more
- Elevance Health (Miami, FL)
- …+ Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate on committees or in ... and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens and… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... will be on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute… more
- Veterans Affairs, Veterans Health Administration (Prescott, AZ)
- …safety data, sentinel event data, appropriateness of clinical practice patterns, and utilization review as reported by committees tasked with these functions. ... access principles. Pulling and reviewing reports related to Psychiatry provider clinic utilization as mapped to the assigned MCA DSS labor report; ensuring maximum… more
- CVS Health (Hartford, CT)
- … Management or clinical operations. + Familiarity with clinical workflows, utilization review processes, and InterQual/MCG guidelines. + Experience working ... Team supports the implementation of strategic initiatives for the Utilization Management (UM) Clinical Services organization. These initiatives leverage advanced… more
- Dignity Health (Los Angeles, CA)
- …90 days of hire. + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... will be on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... emphasis will be on care coordination communication and collaboration with utilization management nursing physicians ancillary departments insurers and post acute… more
- Nuvance Health (Poughkeepsie, NY)
- …Nursing, BSN preferred. Must have current RN license. *Preferred Experience: * Utilization Review /Management.Company: Vassar Brothers Medical Center Org Unit: ... from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within the assigned… more
- Select Medical (Lake Worth, FL)
- …and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management, discharge planning, treatment plan ... patient-specific, safe and timely discharge plan. + Performing verification of utilization criteria reviews. + Building relationships and coordinating with payor… more