- AmeriHealth Caritas Health Plan (Washington, DC)
- …for approval or denial decisions Identify and escalate complex cases requiring physician review or additional intervention Ensure compliance with Medicaid ... to efficiently document and assess patient cases Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- Conway Behavioral Health (Conway, AR)
- …the needs of third party payers in a timely manner. Assist in admissions review , concurrent reviews and discharge planning. Assist physician in peer review ... PURPOSE STATEMENT: Provide administrative support to the Utilization department. ESSENTIAL FUNCTIONS: Perform pre-certification and negotiate continued stay with… more
- Riverside Health System (Hampton, VA)
- …and Care Management team members based upon a thorough medical record review and knowledge of federal and evidence-based guidelines, including CMS Conditions of ... Communicates effectively and professionally regarding modality. Provides education regarding utilization management to patients, families, and other members of the… more
- UHS (Temecula, CA)
- …Southwest Healthcare Regional office in Temecula, CA is seeking a Full-Time RN Central Utilization Review Nurse who will be responsible for carrying out ... ensure correct payer source for hospitalization and communication. Ensures compliance of utilization review practices as required by payers, external regulatory… more
- NORTH EAST MEDICAL SERVICES (Burlingame, CA)
- …Salary Range $128752.00 - $165048.00 Salary Description SUMMARY OF POSITION: The Utilization Management (UM) Nurse is a licensed nursing professional responsible for ... will work closely with the UM/QI Manager, MSO UM team, MSO Medical Director, and MSO Physician Reviewer on UM case reviews. The UM Nurse will also work with the MSO… more
- Trinity Health (Silver Spring, MD)
- …of hospitalization, LOC status, LOS management, continued stay decisions, clinical review of patients, utilization review activities, resource ... and Accreditation: Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR) LOC and clinical documentation. 5. Revenue… more
- WMC Health (Valhalla, NY)
- …management areas of Integrated Case Management including mentoring/coaching care coordinators, utilization review staff and social workers. Reviews cases for ... objectives. This position plays an important role in ensuring physician support and execution of for Utilization ... guidelines and parameters to assure consistency in the review process to reflect appropriate utilization and… more
- TurningPoint Healthcare Solutions, LLC (Lake Mary, FL)
- …appeal considerations. Conduct peer-to-peer consultations, adverse determinations, and appeals for drug utilization review , if not prohibited by state laws or ... Medical Director/ Physician Reviewer- Spine Who We Are: TurningPoint Healthcare...medical necessity. Reviewing cases which were not approved by pre- review screening process or by the initial Clinical Reviewer's… more
- Dignity Physician Careers (Salt Lake City, UT)
- …the State of Utah Certification by American Board of Quality Assurance & Utilization Review Physicians (ABQAURP), preferred. Physical Requirements Medium Work - ... Opportunity Criteria Specialty: Administration : Physician Advisor Candidate Type: MD, DO Visas Accepted:...assigned sites. This position provides support to the facility Utilization Management Committees, medical staff, UM Hub, and care… more
- Johns Hopkins University (Baltimore, MD)
- The Department of Emergency Medicine is seeking a Sr. Physician Assistant experienced in Emergency Medicine to work collaboratively within a multidisciplinary health ... history. Recognize abnormal and significant findings and discuss with attending physician as appropriate. Order diagnostics and interpret abnormal findings. Discuss… more
Recent Jobs
-
Forklift Assistant- Swing Shift
- ManpowerGroup (Pevely, MO)
-
Senior Workers Compensation Examiner- Federal Claims
- AIG (Atlanta, GA)
-
Assistant Professor or Associate Professor-Environmental Engineering
- Montana Tech (Butte, MT)
-
Paint Sales Representative - Kailua-Kona, Hawaii
- HPM Building Supply (Kailua Kona, HI)