- 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 ... RN Case Manager **Position Summary** At Stony Brook Medicine, a...cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to… more
- MVP Health Care (Rochester, NY)
- …functional capability through the coordination of quality cost effective care. The Case Manager will also monitor and review cases with the Medical Director ... innovative thinking and continuous improvement. To achieve this, we're looking for a Case Manager , Medicaid Long Term Support Program to join #TeamMVP. If you have a… more
- Alameda Health System (San Leandro, CA)
- …preferred. Minimum Experience: Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience or ... SLH Case Manager RN + San Leandro, CA + San...resource Management issues; other issues including concerns involving under/over utilization , avoidable days and quality issues. Coordinate daily with… 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 ... Interqual(R) clinical guidelines; refers questionable cases to the CM Manager or physician advisor for determination. + Takes appropriate...experience in Case Management in an acute setting or utilization review at a medical group or… more
- 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
- Beth Israel Lahey Health (Plymouth, MA)
- …is expanding its **Care Transitions Department** and seeking an experienced ** Manager of Utilization Review & Denials Management** and ** Utilization ... or other case management certification preferred or in progress ** Manager - Utilization Review & Denials Management** This role is ideal for a Manager… more
- Nuvance Health (Danbury, CT)
- …the direct oversight of daily operations of clinical denial prevention and Utilization Review (UR) activities, including daily collaboration with physicians as ... departments, team members, providers, delegates, and community partners. In addition, the Manager Denials Prevention & Appeals Operations is responsible for… more
- Hartford HealthCare (Farmington, CT)
- …practices. *_Position Responsibilities:_* *Key Areas of Responsibility* *Denial Resolution* . Review DRG validation denials from payers, analyze the denial ... The Denial Specialist 2 is responsible for reviewing, analyzing, and appealing denials related to DRG (Diagnostic Related Group) validation denials . This… more
- Catholic Health (Buffalo, NY)
- …(the payers) and internal stakeholders including, but not limited to, Utilization Review , Case Management, Clinical Documentation Integrity, Health Information ... any other certification approved by management + Certification in a Nationally Recognized Utilization Review Criteria set is preferred EXPERIENCE + Minimum of… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.This is a full-time role and will be required to work ... respond to all concurrent and post-discharge third party payer denials of outpatient and inpatient cases alleged to be...required or completed within three years of hire **Title:** * Manager - Utilization Review * **Location:**… more
