- Sutter Health (Sacramento, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness ... services. The PA will develop expertise on matters regarding physician practice patterns, over- and under- utilization of...excellence in the patient experience. **Job Shift:** Days **Schedule:** Full Time **Days of the Week:** Monday - Friday… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... determinations + Recent work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare, Medicaid, and Managed… more
- Commonwealth Care Alliance (Boston, MA)
- …Group **Position Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director ... our rapidly growing membership. The incumbent will have significant experience with utilization review , ideally experience with public programming, and excellent… more
- AdventHealth (Glendale Heights, IL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated leader for additional review as determined by… more
- Baptist Memorial (Meridian, MS)
- Overview RN Utilization Review Weekender Job Code: 22818 FLSA Status Job Family: NURSING Job Description Title: RN Utilization Review Weekender Job ... appropriateness of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works...necessity or other areas when indicated + Communicates with physician advisors related to status concerns or denials +… more
- Beth Israel Lahey Health (Plymouth, MA)
- …you're not just taking a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management ... **Job Type:** Regular **Time Type:** Full time **Work Shift:** Day (United States of...causes of denials for discussion with the internal team, physician advisor and the Utilization Review… more
- AmeriHealth Caritas (LA)
- …for approval or denial decisions. + Identify and escalate complex cases requiring physician review or additional intervention. + Ensure compliance with Medicaid ... efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of ... want to make an impact. HonorHealth offers a diverse benefits portfolio for our full -time and part-time team members designed to help you and your family live your… more
- Beth Israel Lahey Health (Burlington, MA)
- …with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities for ... **Job Type:** Regular **Time Type:** Full time **Work Shift:** Day (United States of...Physician Advisors Works collaboratively managing the process of Utilization Review throughout the system **As a… more
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