- Alameda Health System (Oakland, CA)
- …for patients, improve the quality of patient care and maximize the efficient utilization of physician and hospital resources. Report to departmental leadership ... Emergency Medicine Physician + Oakland, CA + Highland General Hospital...with EM Chair and or Vice Chair annually to review yearly goals and expectations. **MINIMUM QUALIFICATIONS** : Education:… more
- Alameda Health System (San Leandro, CA)
- …necessarily performed by each individual in the classification. + Coordinates all utilization review functions, including response to payor requests for ... guidelines; refers questionable cases to the CM Manager or physician advisor for determination. + Takes appropriate action when...experience in Case Management in an acute setting or utilization review at a medical group or… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …results-driven **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical directors/ physician reviewers, network physicians, and ... evenings and weekends, to address pharmacy-related denials + Educates physician reviewers and clinical review staff on...license + 3+ years Nursing experience + 1+ years Utilization Management and Appeals experience + Excellent verbal, written… more
- Alameda Health System (San Leandro, CA)
- …preferred. Minimum Experience: Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience or ... disposition of Medi-Cal, self-pay, and out-of-plan patients, including working with physician to determine readiness for transfer, securing placement and completing… more
- OhioHealth (Mansfield, OH)
- …(COTA) and rehab technicians. Is involved in department quality improvement through utilization review and quality assurance program. Takes active role in ... 90% Direct Patient Care - Evaluates and treats patients after physician referral to: Evaluate patient's motor, cognitive, sensory integrative and/or psychosocial… more
- Somatus (Mclean, VA)
- …+ Travel (up to 25%) to local renal care providers for quality oversight and utilization review collection + Other duties as assigned. _Please note this job ... and policies of Somatus + Assist Directors of Quality on quality and utilization audits as assigned, including targeted audits as requested by the Director. +… more
- Stanford Health Care (Palo Alto, CA)
- …+ Uses independent judgement to assess, identify, and prioritize clinical information to physician , NP, PA and other clinicians for patients who are being evaluated ... care as defined by the research protocol with the physician and other health care professionals and research team...site visits and study close-outs; and collaborates on the review of documentation during protocol audits. + Develops protocol… more
- Alameda Health System (San Leandro, CA)
- …staff, visitors, and volunteers. 8. Assures that the facility complies with all utilization review and case management requirements of Alameda County, AHS, and ... of the Medical Director for John George Psychiatric Hospital by leading physician services specific to acute psychiatric care. 3. Liaison with Alameda County… more
- Stony Brook University (Stony Brook, NY)
- …Required to perform Donor and Therapeutic Apheresis as assigned.. + Perform blood utilization quality assurance, donor related work as assigned. + Required to cover ... education and instructions are consistent with that of the physician or designee. + Communicates and works effectively with...or for a maximum of 90 days. An initial review of all applicants will occur two weeks from… more
