- Tenet Healthcare (Detroit, MI)
- Group Director Utilization Review - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves patients ... in Southeast Michigan. Summary Description SUMMARY: The Group Director, Utilization Review will perform the functions necessary...based on Medical Necessity and submits case for Secondary Physician review per Tenet policy Ensures timely… more
- The County of Los Angeles (Los Angeles, CA)
- …Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician member of the ... UTILIZATION REVIEW NURSE SUPERVISOR II Print...$177,314.88 Annually Location Los Angeles County, CA Job Type Full time Job Number Y5126D Department HEALTH SERVICES Opening… 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 ... **Job Type:** Regular **Time Type:** Full time **Work Shift:** Day (United States of...billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review … 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
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... of InterQual Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of CMS Regulations. **Working… 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
- Houston Methodist (The Woodlands, TX)
- …improvements, patient satisfaction). **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates with the physician and all members of the interprofessional health care team to ... for the department and the hospital. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource use,… more
- Dignity Health (Gilbert, AZ)
- …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the...ensure progression of care. + Engages the second level physician reviewer, internal or external, as indicated to support… more
- Baptist Memorial (Jackson, MS)
- Overview Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and 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
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