- Hackensack Meridian Health (Hackensack, NJ)
- The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical ... Hackensack University Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, 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 use ... an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the… more
- Hackensack Meridian Health (Brick, NJ)
- …outcomes. + Board Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) preferred. + Membership in the American ... Medical Center** is seeking a highly motivated and experienced physician to join our team as a **Senior** **...with leadership skills to optimize patient care and resource utilization within our dynamic healthcare environment. As a key… more
- Mount Sinai Health System (NJ)
- …with their job descriptions and the VMG Compact + Participate in the annual physician performance review process in Oncology Services + **Engage in the ... and the Mount Sinai Health System mean our doctors collaborate with the top physician leaders in medicine today. The Valley Hospital is one of the region's busiest… more
- Virtua Health (Marlton, NJ)
- …Palliative Care and Hospice Team members to assure that clinical protocols, utilization review , case management, quality assurance, and compliance Programs are ... than 14,000 colleagues, including over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies,… more
- Highmark Health (Trenton, NJ)
- …DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the multidisciplinary team ... Inc. **Job Description :** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in… more
- Evolent (Trenton, NJ)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... requested basis, reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician Business… more
- NJM Insurance (Parsippany, NJ)
- …and Auto (PIP/Medpay) lines of business by performing prospective and retrospective Utilization Review of medical services/treatment requested or rendered by ... to uphold, modify, or overturn prior decisions. + Conduct Inpatient Care utilization review using NJM and evidence-based clinical guidelines to ensure… more
- RWJBarnabas Health (New Brunswick, NJ)
- …unit department utilizing effective and efficient tools/techniques to enhance physician and patient satisfaction, Collaborates with the department Director to ... department schedule, providing continuous and high-quality service for the patient, physician , and staff, Relates effectively with entire department for continuity… more
- RWJBarnabas Health (New Brunswick, NJ)
- …referrals to Physician Advisor as needed, + Collaborates with the Utilization Review team regarding medical necessity of inpatient admission, appropriate ... Community Health Nursing Preferred: + Case Management certification preferred. + Utilization review and/ or discharge planning experience preferred.… more
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