- Emanate Health (Covina, CA)
- …the United States, and the #19 ranked company in the country. **J** **ob Summary** The Manager , Medical Necessity Review & Appeals is responsible for ... overseeing the evaluation of medical necessity , appropriateness, and cost-effectiveness of healthcare...rates, reduce denials, and support optimal patient care. The Manager collaborates with clinical and operational leaders, and drives… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …development specialist to develop standard work and expectations for the utilization review process, including timely medical necessity screening to ... *_SUMMARY:_* We are currently seeking a*Utilization Review Manager * to join ourTransitional Care...payers, as appropriate * May participate in the Utilization Review Committee to present medical necessity… more
- Children's Mercy Kansas City (Kansas City, MO)
- …practice guidelines to determine the appropriate level of care and the medical necessity of continued hospitalization. Secures initial payer authorization and ... patient throughput progression; securing continued stay authorizations; continually reassessing medical necessity ; and partnering with the multidisciplinary… more
- Virtua Health (Pennsauken, NJ)
- …holiday, 1 winter and 1 summer. Summary:Responsible for application of appropriate medical necessity tools to maintain compliance and achieve cost effective ... as a resource to assist in the determination process regarding level of service and medical necessity .* Consults with Physician Advisor to discuss medical … more
- Children's Mercy Kansas City (Kansas City, MO)
- …resource management of patients, including patient statusing processes, ongoing monitoring of medical necessity review functions utilizing InterQual and/or ... quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome focused family… more
- Molina Healthcare (Warren, MI)
- … Claims Review . + Minimum two years of experience in Claims Auditing, Medical Necessity Review and Coding experience + Familiar with state/federal ... and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal… more
- US Tech Solutions (Columbia, SC)
- …to assess, plan, implement, health coach, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services ... /authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Assesses service needs, develops and… more
- US Tech Solutions (Columbia, SC)
- …of healthcare continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity , options, and services required to support members in ... /authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up… more
- Tenet Healthcare (Detroit, MI)
- …individuals responsibilities include the following activities: a) accurate medical necessity screening and submission for Physician Advisor review , b) care ... provided at the appropriate level of care based on medical necessity and to assess the patient...Necessity process and submits case for Secondary Physician review per Tenet policy. Ensures timely communication of clinical… more
- AdventHealth (Kissimmee, FL)
- …rounds. Care coordination, discharge planning, transitions of care planning and understanding of medical necessity are core competencies of this role. The RN ... physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity , CMS CoP for Discharge Planning and care coordination.… more