- Community Health Systems (Franklin, TN)
- …collaborates with healthcare providers to facilitate efficient patient care . The Clinical Utilization Review Specialist monitors adherence to hospital ... **Job Summary** The Part-Time Clinical Utilization Review Specialist ...+ 2-4 years of clinical experience in utilization review, case management, or acute care … more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Quality Reporting and Auditing Specialist I Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, ... net required to achieve that purpose. Job Summary The Utilization Management (UM) Quality Reporting and Auditing Specialist...auditing work plans and projects on behalf of LA Care 's Utilization Management Quality Program by working… more
- Hunterdon Health Care System (Flemington, NJ)
- This is an in-person role. Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure the ... of an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... department and hospital. Provides education to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of… more
- CareFirst (Baltimore, MD)
- …authorization, appropriateness of care determination and benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review ... Nurse Specialist Preferred **Experience:** 5 years Clinical nursing experience. 2 years Care Management...5 years Clinical nursing experience. 2 years Care Management and/or Utilization Management. **Preferred Qualifications:**… more
- CaroMont Health (Gastonia, NC)
- …requested. Assesses for best utilization regarding level of patient care , diagnostic testing, and clinical procedures without jeopardizing patient quality ... to managed care organizations. Communicates with attending physicians regarding utilization issues. Collaborates with discharge planning specialist and other… more
- BriteLife Recovery (Englewood, NJ)
- …by effectively communicating clinical information and advocating for appropriate levels of care . The UR Specialist works closely with clinical staff, ... What you will be doing? The Utilization Review (UR) Specialist is a...for the organization. Success in this role requires strong clinical judgment, documentation skills, familiarity with ASAM criteria, and… more
- Cleveland Clinic (Cleveland, OH)
- …with one of the most respected healthcare organizations in the world. As a Utilization Management Specialist , you will perform UM activities, such as admission, ... concurrent, retrospective chart and clinical systems reviews to measure clinical performance...advance and enhance the patient experience and delivery of care across the hospital. **A caregiver in this position… more
- HonorHealth (AZ)
- …Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of health care services with the goal of maintaining high quality ... group with primary, specialty and urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a… more
- AnMed Health (Anderson, SC)
- …here. This position is responsible for performing the daily operations of the Utilization Management program at AnMed within the Care Coordination model. These ... + Uses clinical knowledge to independently review the medical record for clinical appropriateness and resource utilization including but not limited to :… more
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