- Great River Health (West Burlington, IA)
- …browser Qualifications + 4-6 years clinical experience Required + Previous experience in Utilization Review Preferred + Knowledge of the structure and content of ... responsible for maintaining compliance with the CMS Conditions of Participation for Utilization Management.What you will do + Review inpatient encounters for… more
- Emory Healthcare/Emory University (Duluth, GA)
- …+ Ongoing mentorship, _development,_ and leadership programs + And more **Description** The Utilization Review (UR) Specialist is responsible for conducting ... judgement, and discussions with the attending physician and/or physician advisor. + The UR Specialist will perform utilization review by completing a timely… more
- Queen's Health System (Honolulu, HI)
- RESPONSIBILITIES I. JOB SUMMARY/RESPONSIBILITIES: * Coordinates and maintains the utilization review process for clinical services including medical, surgical ... Clinics (QEC). * Performs duties and responsibilities in accordance with utilization tracking and prior authorization procedures. * Assists with coordinating and… more
- Nuvance Health (Danbury, CT)
- …duties as required. Education: ASSOCIATE'S LVL DGRE Preferred- Two Years Utilization Review Experience Working Conditions: Manual: significant manual ... *Description* Summary: The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary team, and organization with the underlying… more
- Vanderbilt University Medical Center (Lebanon, TN)
- …that the appropriate admission status is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary ... between 7a-8a and end at 3:30p-4:30p). This is a 40 hour a week position. 20 hours will be...* Clinical Applications Systems (Novice): Possesses fundamental proficiency in utilization review systems, clinical support systems and… more
- Sanford Health (Sioux Falls, SD)
- …**Shift:** 8 Hours - Day Shifts **Job Schedule:** Full time **Weekly Hours:** 40 .00 **Salary Range:** $24.00 - $38.50 **Department Details** Monday through Friday, 8 ... level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to assure… more
- Ascension Health (Baltimore, MD)
- …process. + Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + ... at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient...sites of care, including more than 140 hospitals and 40 senior living communities in 19 states. Our Mission,… more
- Henry Ford Health System (Bingham Farms, MI)
- …of pharmacy services, decrease waste, and rework in the region, and improve drug utilization . The Pharmacy Specialist will be instrumental in guiding the further ... GENERAL SUMMARY: The Pharmacy Specialist provides oversight and leadership for appropriate drug...provided by the primary care team. He/she works with utilization management reports, corporate data stores, and information services… more
- Trinity Health (Troy, NY)
- …college level course in medical terminology. + One year of case management or utilization review /billing or coding experience. + One year of experience in ... utilization reviews with the facilities Per Diem- Insurance Specialist to assist with authorizations for Substance abuse and...related field + One year of case management or utilization review , billing, or coding experience Please… more
- Abbott (Plano, TX)
- …required clinical information for authorizations. + Work with respective carrier's utilization review department to obtain appropriate authorizations. + Assist ... insurance, Worker's Compensation and Medicare guidelines pertaining toProspective and Retrospective Utilization Review . Some experience in medical deviceor DME… more