- Sutter Health (Sacramento, CA)
- …Advisor will work closely with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management (CM) personnel to ... services. The PA will develop expertise on matters regarding physician practice patterns, over- and under- utilization of...within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation… more
- Hackensack Meridian Health (Hackensack, NJ)
- The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of ... Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management , and transitions of… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print...Review Nurse is an RN that has Case Management experience whose primary charge is to ensure that ... (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I Salary $111,656.88 - $167,136.48 Annually… more
- UPMC (Pittsburgh, PA)
- The Regional Medical Director, CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. This ... hospital in their region. Key Responsibilities + Leadership & Management **: + Oversee Utilization Management ...care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote… 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 ...causes of denials for discussion with the internal team, physician advisor and the Utilization Review… more
- Commonwealth Care Alliance (Boston, MA)
- …local regulatory guidelines. + Serve as the lead for CCA's Utilization Review functions working closely with other medical management team members. + Support ... case review findings, actions, and outcomes in accordance with Utilization + Management policies; meets health plan inter-rater reliability guidelines… more
- Beth Israel Lahey Health (Boston, MA)
- …a difference in people's lives.** Position Summary: In conjunction with the admitting/attending physician , the Utilization Review RN assists in determining ... the level of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …the appropriate utilization of resources, coordination of payer communication, and utilization review and management . Responsible for carrying out duties ... *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional...functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to… more
- Guthrie (Binghamton, NY)
- …services regarding admissions, case management , discharge planning and utilization review . Responsibilites: Reviews admissions and service requests within ... planning needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to… more
- CommonSpirit Health (Phoenix, AZ)
- …by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. + Physician Advisor Sub-specialty Certification ... **Responsibilities** The System Vice President of Utilization Management is a key member...by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. **Required… more
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