- Hackensack Meridian Health (Hackensack, NJ)
- The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical ... records for the patient population and Hackensack University Medical Center. These include but are not limited to... Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case… 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 ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Hackensack Meridian Health (Hackensack, NJ)
- …(APN) or Physician Assistant (PA) for the Transition Utilzation Review Team utilizes a patient-centered coordinated care model, demonstrating competencies in ... Knowledge, Skills and Abilities Required: 1. Successful completion of an approved physician 's assistant program, accredited by the AMA Council on Medical … more
- The County of Los Angeles (Los Angeles, CA)
- …recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the committee of new or ... Medi-Cal reimbursement. + Analyzes cases for referral to the physician advisor to ensure that the admission or continued...I:One year of experience performing the duties of a Utilization Review Nurse* or Medical … more
- Integra Partners (Troy, MI)
- …as operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director(s), ensures consistent application of ... representing Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director's responsibilities include but… more
- The County of Los Angeles (Los Angeles, CA)
- …administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the ... Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician...for and the effective conduct of the system to review patients' medical charts to ascertain the… more
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the...intensity of services, escalating cases as necessary to payers, physician advisors, leadership, or the medical team.… more
- St. Peters Health (Helena, MT)
- …with the MD advisor or physician consultant(s) on any cases sent for physician review . 4. Performs daily utilization reviews on all patients admitted ... The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN...admission status and identifies related quality measures to promote medical compliance. 14. Collaborates with admitting physician ,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …professional development specialist to develop standard work and expectations for the utilization review process, including timely medical necessity ... actions to UR Committees, as appropriate * Partners with Physician Advisor to engage in second level review...with payers, as appropriate * May participate in the Utilization Review Committee to present medical… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review - Case Management -... Medical Necessity and submits case for Secondary Physician review per Tenet policy Ensures timely ... management system Follows the payor dispute processes utilizing secondary medical review , peer to peer and payor...level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as… more
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