- Cleveland Clinic (Cleveland, OH)
- …career with one of the most respected healthcare organizations in the world. As a Utilization Management Specialist , you will perform UM activities, such as ... discharge plan. + Achieve a minimum of 85% on IRR quarterly. + Complete Utilization Management for assigned patients with a minimum of 25-30 reviews per day. +… more
- Penn State Health (Hershey, PA)
- …status, and family medical or genetic information._ **Union:** SEIU Healthcare Pennsylvania **Position** Utilization Management Specialist - Utilization ... responsible for maintaining compliance with the CMS Conditions of Participation for Utilization Management . MINIMUM QUALIFICATIONS: * Bachelors Degree in Nursing… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Vanderbilt University Medical Center (Lebanon, TN)
- …preeminent programs in patient care, education, and research. **Organization:** Utilization Management 10 **Job Summary:** Facilitates optimal reimbursement ... appropriate admission status is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary review when… more
- Sanford Health (SD)
- …Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to ... potentially, prior authorization. Assists the department in monitoring the utilization of resources, risk management and quality...in monitoring the utilization of resources, risk management and quality of care for patients in accordance… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Utilization Management Specialist , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: ... to be named a Forbes "Best Employer" seven times. Position Summary: The Utilization Management Specialist I will perform utilization management … more
- Geisinger (Danville, PA)
- …rewarding, lasting career with impact. Job Duties The RN Clinical Access Specialist performs initial, concurrent and retrospective medical record review to determine ... suggests alternatives and assists in ensuring documentation integrity. + Enters utilization review data into database for tracking and trending audits, billing… more
- Sharp HealthCare (San Diego, CA)
- …and employer business practices. **What You Will Do** The Provider Relations Specialist is responsible for the development and maintenance of positive working ... Qualifications** + Bachelor's Degree Business, marketing, or health care management . **Other Qualification Requirements** + Utilizes reliable transportation and… more
- MyFlorida (Tallahassee, FL)
- …Field Office locations Position Overview and Responsibilities This position serves as the Data Utilization Specialist in the Data Management Office, in the ... 68065000 - SENIOR DATA BASE ANALYST/DATA UTILIZATION SPECIALIST Date: Apr 18, 2025...Health Care Administration and reports directly to the Data Management Administrator. FX is tasked with the modernization of… more