- Commonwealth Care Alliance (Boston, MA)
- …for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized ... reviews). - Hire, train and mentor UM staff, including nurse reviewers and support personnel. - Act as liaison...Skills & Abilities (must have): - Expertise in managing utilization review processes including prior authorization, concurrent… more
- Katmai (Fort Carson, CO)
- …RESPONSIBILITIES** None. **Job Requirements:** **MINIMUM QUALIFICATIONS** + Associates Degree of Nursing. Registered nurse shall be a graduate from a college or ... those required of any military or government civil service nurse of similar experience and in similar duty assignments....+ Shall possess a current, active, full and unrestricted Registered Nurses ( RN ) licensed in Colorado or… more
- CoxHealth (Lake Spring, MO)
- …feedback for the following Committees: 1) Coding and Documentation Committee 2) Utilization Review Committee 3)SOI Scorecard Committee 4) Educational sessions ... order to analyze data to determine when to mentor and educate CDI Specialist (s) to improve their practice. Additionally will be responsible for assisting providers… more
- Commonwealth Care Alliance (Springfield, MA)
- …to influence the outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment and closing gaps in care through connecting patients ... services. The CHW will play an integral role supporting patients with frequent utilization of Emergency Departments and acute admissions with the goal of identifying… more
- Commonwealth Care Alliance (Boston, MA)
- …skills to improve CCA enrollee outcomes by impacting care access and utilization , closing care quality gaps, and optimizing member connection to medical, behavioral ... role in reducing high emergency department (ED) and inpatient utilization related to unmet social needs, including housing, food,...manner; promote and enforce the CCA compliance program + Review the Code of Conduct at least annually and… more
- Commonwealth Care Alliance (Springfield, MA)
- …influence the clinical outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment for behavioral health needs, and closing quality ... Timely Psychiatric post hospital discharge with focus on hospitalization and utilization reduction + Facilitating and/or delivering preventative care and behavioral… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services ... healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence...regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse -… more
- Medical Center Hospital (Odessa, TX)
- + Position Summary: The Utilization Review Specialist /Outcomes Specialist conducts concurrent and retrospective review functions in support of the ... hospital Utilization Review Program and makes appropriate referrals to designated Physician...A. Education: Holds a current Texas license as a Registered Nurse OR a current Texas Licensed… 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 ... an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is ... responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD)… more
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