- Alameda Health System (Oakland, CA)
- …for patients, improve the quality of patient care and maximize the efficient utilization of physician and hospital resources. Report to departmental leadership ... AHMG Emergency Medicine Physician + Oakland, CA + Highland General Hospital...with EM Chair and or Vice Chair annually to review yearly goals and expectations. **MINIMUM QUALIFICATIONS** : Education:… more
- Houston Methodist Hospital (Houston, TX)
- …while providing excellent customer/patient service. Plays a leadership role in utilization review committee which includes identification of opportunities for ... most clinically appropriate care to patients while promoting the most cost-effective utilization of the hospital's resources. The Director Case Mgmt Social Svcs… more
- Alameda Health System (San Leandro, CA)
- …necessarily performed by each individual in the classification. + Coordinates all utilization review functions, including response to payor requests for ... guidelines; refers questionable cases to the CM Manager or physician advisor for determination. + Takes appropriate action when...experience in Case Management in an acute setting or utilization review at a medical group or… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …results-driven **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical directors/ physician reviewers, network physicians, and ... evenings and weekends, to address pharmacy-related denials + Educates physician reviewers and clinical review staff on...license + 3+ years Nursing experience + 1+ years Utilization Management and Appeals experience + Excellent verbal, written… more
- Valley Health System Consolidated Services (Las Vegas, NV)
- …and retrospective review of inpatient medical records to evaluate the utilization and documentation of acute care services. The goal of concurrent review ... includes facilitation of appropriate physician documentation of care delivered to accurately reflect patient severity of illness and risk of mortality. Specific reviews are both determined internally and by requirements/requests of external payers or… more
- ChristianaCare (Newark, DE)
- …Social Worker - Resolves psycho-social barriers and supports discharge needs. Utilization Management - Reviews patient status for appropriateness and anticipated ... discharge plan for patients with post-acute care needs, collaborating with the physician , nurse, and other health care providers, the patient, their family/primary… more
- Fresenius Medical Care (Knightdale, NC)
- …auditing activities. Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. Manages clinic financials ... including efficient utilization of supplies or equipment and regular profits and loss review . Responsible for all required network reporting and on-site state or… more
- Fresenius Medical Care (Dallas, PA)
- …staff in problem solving. PHYSICIANS: Facilitates the application process for physician privileges and compliance with FMS Medical Staff By-Laws. Responsible for ... strong Director and physician relationships and facilitating staff relationships with physicians. Ensures...manuals. Accountable for completion of the Annual Standing Order Review and ICD coding. Checks correspondence whether electronic, paper… more
- Fresenius Medical Care (Anderson, IN)
- …treatments in contracted hospitals/facilities and ensure efficient patient scheduling and staff utilization in accordance with the TAP scheduling tool. Maintain and ... review the daily TAP tool for all hospitals/facilities under...daily patient care needs and communicate concerns to attending physician . Implement changes in patient care/treatment as directed and… more
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