- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, ... in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely...for appropriate care and setting while working closely with denial coordinators and other staff to ensure the accurate… more
- Prime Healthcare (Philadelphia, PA)
- …coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for ... all communication attempts with insurance providers and health plans. Utilization review tech will follow up on...Education and Work Experience 1. Minimum one year denials management experience in acute care setting highly preferred.2. High… more
- Prime Healthcare (Passaic, NJ)
- …coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for ... and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely with… more
- Prime Healthcare (Chicago, IL)
- …coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for ... plans and scan all related correspondence to the respective EMR/ tracking tool. Utilization review tech will follow up on all denials while working closely with… more
- Baptist Memorial (Memphis, TN)
- …obtaining authorizations, claims review , patient billing, appeal writing, auditing, and/or denial management ; 3-5 years case management experience, or ... accredited nursing program Training Description Minimum Required Preferred/Desired Nursing, Case Management or Denial Management . Familiarity with electronic… more
- Baptist Memorial (Memphis, TN)
- …obtaining authorizations, claims review , patient billing, appeal writing, auditing, and/or denial management ; 3-5 years case management experience, or ... accredited nursing program Preferred/Desired Training Description Minimum Required: Nursing, Case Management or Denial Management . Familiarity with… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management ...they pertain to level of care determination and the appeal/ denial process. + Oversees utilization review… more
- Tenet Healthcare (Detroit, MI)
- …and advance Tenet’s Case Management strategy with the specific focus on Utilization Review for the designated Market. Will support the advancement of ... initiatives and will provide subject matter expertise for Case Management – Utilization Review regulations...of daily operations of the UM team and optimizing denial mitigation processes. Will partner with the Group DCM… more
- Sutter Health (Sacramento, CA)
- …resources, medical necessity, documentation best practices, level of care progression, denial management and compliance with governmental regulations and ... with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management...within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation… more
- AmeriHealth Caritas (Dover, DE)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… more