• Manager - Utilization Review…

    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 (07/29/25)
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  • Care Transitions Jobs

    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
    Beth Israel Lahey Health (07/03/25)
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  • Denials Specialist 2 / HIM Coding

    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
    Hartford HealthCare (07/01/25)
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  • Denials and Appeals Nurse

    Dayton Children's Hospital (Dayton, OH)
    Facility:Work From Home - OhioDepartment: Utilization Review TeamSchedule:Full timeHours:40Job Details:Reporting to the Manager of Utilization Management ... Management; supports the development and implementation of a comprehensive denials management program. This role functions as a hospital...in a hospital required + 3-5 years as progressive utilization review nurse and knowledge of payers… more
    Dayton Children's Hospital (09/05/25)
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  • Utilization Review Manager

    Minnesota Visiting Nurse Agency (Minneapolis, MN)
    *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.Thisis a full-time role. *Purpose of this position: ... ) required or completed within three years of hire **Title:** * Utilization Review Manager * **Location:** *MN-Minneapolis-Downtown Campus* **Requisition… more
    Minnesota Visiting Nurse Agency (08/08/25)
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  • Manager , Utilization Review

    Children's Mercy Kansas City (Kansas City, MO)
    …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
    Children's Mercy Kansas City (06/17/25)
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  • Clinical Utilization Review…

    Community Health Systems (Franklin, TN)
    **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… more
    Community Health Systems (09/03/25)
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  • Revenue Utilization Review (RUR)…

    Veterans Affairs, Veterans Health Administration (Orlando, FL)
    …of VHA and industry best standards. Responsibilities Responsibilities of the RUR Nurse Manager (NM) include, but are not limited, to the following: RUR Nurse ... Manager is accountable to the Consolidated Patient Account Center...the Community, DME, and Ambulance. Conducts clinical legal relatedness review for Regional Counsel TORT Claims, No Fault, and… more
    Veterans Affairs, Veterans Health Administration (09/04/25)
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  • Utilization Review RN

    Virginia Mason Franciscan Health (Bremerton, WA)
    …1. Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted ... for appropriate status determination. 2. Ensures compliance with principles of utilization review , hospital policies and external regulatory agencies, Peer… more
    Virginia Mason Franciscan Health (09/07/25)
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  • Utilization Review Coordinator

    Behavioral Center of Michigan (Warren, MI)
    …skills to help educate the staff and physicians regarding charting. REPORTS TO: Utilization Review Lead/ Manager QUALIFICATIONS: + High School Diploma or ... those duties include all tasks requested by the UR Manager , CEO or Medical Director to meet the needs...denials . Responds to complaints per UR guidelines. Maintains utilization review and appeal logs, as needed.… more
    Behavioral Center of Michigan (09/11/25)
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