- Sutter Health (Sacramento, CA)
- …expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical necessity, documentation best practices, level ... physician Advisor will work closely with the medical staff, including house staff, and all utilization...within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation… more
- Ochsner Health (New Orleans, LA)
- …Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (3) Physician Advisor Sub-Specialty Certification by ... the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (4) commitment...MCG / InterQual screening criteria, Medicare / Medicaid compliance, medical staff structure, policies and procedures + Physician… 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
- Tenet Healthcare (Detroit, MI)
- …of care based on Medical Necessity and submits case for Secondary Physician review per Tenet policy Ensures timely communication and documentation of ... management supporting medical necessity and denials prevention. Utilization Management Monitors the review process to...medical staff on actionable items Implements and monitors physician “peer to peer” review process with… more
- Intermountain Health (Las Vegas, NV)
- …appeals levels 1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims ... care management, claims, network management, and finance. As the Medical Director for Utilization Management, you are...review , quality assurance, and medical review of complex, controversial, or experimental medical … 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
- Emory Healthcare/Emory University (Duluth, GA)
- …and leadership programs + And more **Description** The Utilization Review (UR) Specialist is responsible for conducting medical necessity reviews ... physician and/or physician advisor. + The UR Specialist will perform utilization review by completing a timely and comprehensive review of all new… more
- Beth Israel Lahey Health (Burlington, MA)
- …you're making a difference in people's lives.** In conjunction with the admitting/attending physician , the Utilization Review RN assists in determining the ... care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for… more
- Trinity Health (Des Moines, IA)
- …(IA), MercyOne Des Moines Join the MercyOne Family! We are looking to hire a Utilization Review RN! Responsible for the review of inpatient and outpatient ... the Case Management staff utilizing admission criteria guidelines-and second level physician review process when appropriate. Interacts with insurance providers… 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 ... and consultant to the multidisciplinary patient care team. The Utilization Review Nurse is responsible for ...of level of care. + Refers cases failing inpatient medical necessity screening to physician advisor for… more
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