- 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
- Nuvance Health (Danbury, CT)
- …any issues/denials to department leadership.* 12) Forwards reviews that require secondary physician review to appropriate resource ( Physician Advisor) 13) ... one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the physician...required. Education: ASSOCIATE'S LVL DGRE Required: 3 Years of Utilization Review experience(or a certification ACMA, MCG,… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Hunterdon Health Care System (Flemington, NJ)
- Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure the effective and efficient ... an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the… more
- Sutter Health (Berkeley, CA)
- …to justify acute hospital admission, need for continued stay, and proper utilization of physician , nursing, and ancillary services. Responsible for concurrent ... with hospital administration, medical staff, patient registration and representatives of review organizations and others to ensure effective utilization of… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Catholic Health Initiatives (Omaha, NE)
- …2 hours of a Commonspirit Health Facility Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact ... our patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! As our… more
- Covenant Health Inc. (Knoxville, TN)
- …and financial data to various audiences as necessary. + Completes daily work lists for utilization review meeting the time frames set forth by Covenant Health. + ... Overview Utilization Management Specialist , Revenue Integrity and...ensure timely follow through for status placement. The UM Specialist collaborates with attending physician if ambiguous… more
- HCA Healthcare (Sugar Land, TX)
- …growth, we encourage you to apply for our Consulting Provider Services Specialist opening. We promptly review all applications. Highly qualified candidates ... care like family! Jump-start your career as a Consulting Provider Services Specialist today with HCA Houston Healthcare. **Benefits** HCA Houston Healthcare, offers… more
- Mohawk Valley Health System (Utica, NY)
- … regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of...and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides… more
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