- Beth Israel Lahey Health (Plymouth, MA)
- …you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding UR… more
- St. Luke's University Health Network (Allentown, PA)
- …role is a Certified Medical Coder who ensures clean claim submission and timely review and resolution of coding related claim denials for professional services, ... after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications. The appeals process may include collaboration… more
- Tenet Healthcare (Detroit, MI)
- …utilization management supporting medical necessity and denials prevention. Utilization Management Monitors the review process to ensure medical necessity ... peer” review process with payers to resolve denials or downgrades concurrently Promotes prudent utilization ...skills including ability to use PowerPoint. · Accredited Case Manager (ACM) or Certified Public Accountant (CPA) preferred, Six… more
- Houston Methodist (The Woodlands, TX)
- …care, resource utilization , and continued stay. Reviews level of care denials to identify trends and collaborate with team to recommend opportunities for process ... At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered...department and the hospital. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and… more
- Dignity Health (Santa Cruz, CA)
- …+ _Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted ... for appropriate status determination._ + _Ensures compliance with principles of utilization review , hospital policies and external regulatory agencies, Peer… more
- Trinity Health (Mason City, IA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **JOB SUMMARY:** The Utilization Review Case Manager responsibilities include case ... as well as commercial payer specific guidelines to prevent denials and revenue loss. Patient outcomes are achieved through...members of care team to effectively ensure appropriate acute utilization management + Interacts with outside review … more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + ... #:41907-31045 + FTE:1 + Posted:Today **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review ...in orientation of fresh staff as requested by the Manager of Utilization Management. 17. Maintains knowledge… 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 ... necessity and appropriateness of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works with providers, insurance… more
- Tufts Medicine (Burlington, MA)
- …**Job Overview** The position provides day to day support and oversight to Utilization Review departments and UM vendor management. Responsible for compliance ... with CMS Conditions of Participation regarding Utilization Review and Discharge Planning including implementation and annual review of the Utilization … more
- Ochsner Health (Lafayette, LA)
- …compliance management systems (CMS) regulations, compliance and quality metrics. Experience managing denials and appeals of all payer cases in a timely and organized ... + Determines appropriate staffing levels and the interviewing, hiring, performance review , and termination of employees within practice unit(s); maintains employee… more