- Integra Partners (Troy, MI)
- …needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director(s), ensures consistent application of criteria, ... & Oversight + Provide day-to-day clinical leadership and oversight to the Utilization Review Medical Director(s) and clinical UM team. + Ensure… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors... of hospital services. + Collaborates with physicians and clinical teams to obtain necessary documentation for medical… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to ... committed to consistency, compliance, and evidence-based decision making. The Utilization Review Medical Director 's...or past OIG or state sanctions + Experience performing utilization management or clinical review … more
- CVS Health (Phoenix, AZ)
- …administration of the utilization /benefit management function. + Gathers clinical information and applies the appropriate medical necessity ... the lives of patients? Join Mercy Care as a Utilization Management Clinical Consultant and become part...knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of… more
- Houston Methodist (Houston, TX)
- …of hospital clinical nursing experience, which includes three years in utilization review and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position...regarding any claim issues or concern that may require clinical review during the pre-bill, audit, or… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …and may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating ... evidence-based practice *Quality of Practice*: * Promotes quality through evidence-based utilization review processes and actively contributes to performance… more
- Community Health Systems (Naples, FL)
- …of care, and accurate clinical documentation. Under the direction of the Utilization Review leadership, this role supports concurrent review processes, ... clinical documentation and make timely, independent decisions regarding medical necessity and care status. + Proficient in ...medical necessity and care status. + Proficient in utilization review processes, admission criteria, and payer… more
- Waystar (Atlanta, GA)
- …end user adoption of best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as an integral contributor in ... **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management...+ bonus, if applicable) + Customizable benefits package (3 medical plans with Health Saving Account company match) +… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …professional development specialist to develop standard work and expectations for the utilization review process, including timely medical necessity ... utilization management activities. The goal is to achieve clinical , financial, and utilization goals through effective...with payers, as appropriate * May participate in the Utilization Review Committee to present medical… more
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient...+ Staff Acquisition and Support: Leads and manages the utilization review staff and function for the… more