- Ochsner Health (New Orleans, LA)
- …Come make a difference at Ochsner Health and discover your future today!** The Physician Advisor (PA- Utilization Management) serves as the physician leader ... and comply with Federal and State regulations/quality initiatives. Reports to the System Medical Director of Utilization . This job description is a summary of… more
- Sutter Health (Sacramento, CA)
- …expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical necessity, documentation best practices, level ... Health Internal Physician Advisor Services (IPAS). The physician Advisor will work closely with the medical... physician Advisor will work closely with the medical staff, including house staff, and all utilization… more
- Hackensack Meridian Health (Hackensack, NJ)
- The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical ... and Hackensack UMC. These include but are not limited to utilization review, hospital reimbursement, clinical compliance, case management, and transitions of… more
- Intermountain Health (Las Vegas, NV)
- … management, care management, claims, network management, and finance. As the Medical Director for Utilization Management, you are responsible, in partnership ... with MG Clinical Leadership, for the appropriate utilization of medical services within established guidelines...(QMMC) and other designated committees defined by the organization. Physician will be engaged in these important projects along… more
- Tenet Healthcare (Detroit, MI)
- Group Director Utilization Review - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves patients ... and safe and timely patient throughput. Will integrate national standards for utilization management supporting medical necessity and denials prevention. … more
- The County of Los Angeles (Los Angeles, CA)
- … direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one ... hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty...utilization review standard. Under the direction of a physician member of the Utilization Review Committee,… more
- AdventHealth (Altamonte Springs, FL)
- …basis to assure resolution of pending denials, which have been referred to the physician for peer-to-peer review with the Medical Director of the insurance ... **The role you will contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use...standards. When screening criteria does not align with the physician order or a status conflict is indicated, the… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- … Utilization Review Nurse combines clinical expertise with knowledge of medical appropriateness criteria, and applies principles of utilization and quality ... of level of care. + Refers cases failing inpatient medical necessity screening to physician advisor for...+ Communicates following the chain of command regarding proper utilization of resources, physician concerns, length of… more
- Beth Israel Lahey Health (Burlington, MA)
- …making a difference in people's lives.** In conjunction with the admitting/attending physician , the Utilization Review RN assists in determining the appropriate ... level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria… more
- Catholic Health Services (Melville, NY)
- …as a liaison between patient account services, physicians, care coordinators, Utilization and Appeals Managers, physician advisors and facility departments. ... a home health service, hospice and a network of physician practices across the island. At Catholic Health, our...Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help… more
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