- Beth Israel Lahey Health (Plymouth, MA)
- …you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding UR… more
- Dignity Health (Phoenix, AZ)
- …Nevada markets. Must have current Arizona and Nevada unrestricted RN license.** The Utilization Management (UM) Manager is responsible for managing day-to-day UM ... necessity determinations; processes appeals and reconsiderations. Act as a working manager within Utilization Management, performing essential duties and… more
- Houston Methodist (The Woodlands, TX)
- …care, resource utilization , and continued stay. Reviews level of care denials to identify trends and collaborate with team to recommend opportunities for process ... At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered...department and the hospital. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and… more
- Hackensack Meridian Health (Hackensack, NJ)
- Sr Utilization Review Spec FT HUMCHACKENSACK UNIVERSITY MED CNTRHackensack, New Jersey Apply ... Day + **Status** Full Time with Benefits **Overview** The Utilization Review Physician collaborates with the healthcare...documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate… more
- Hackensack Meridian Health (Hackensack, NJ)
- Physician Utilization Review Specialist Per Diem HUMCHACKENSACK UNIVERSITY MED CNTRHackensack, New Jersey Apply ... **Shift** Day + **Status** Per Diem **Overview** The Senior Utilization Review Specialist collaborates with the healthcare...documentation e. Target DRGs Reviews f. Use of case manager as a resource + Uses guidelines to evaluate… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + ... FTE:1 + Posted:April 10, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review ...in orientation of fresh staff as requested by the Manager of Utilization Management. 17. Maintains knowledge… more
- BayCare Health System (Clearwater, FL)
- …foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions ... the supervisor including but not limited to processing concurrent denials . + Preferred experience includes Critical Care or Emergency...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- Ochsner Health (Lafayette, LA)
- …compliance management systems (CMS) regulations, compliance and quality metrics. Experience managing denials and appeals of all payer cases in a timely and organized ... + Determines appropriate staffing levels and the interviewing, hiring, performance review , and termination of employees within practice unit(s); maintains employee… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Alameda Health System (Oakland, CA)
- …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating in ... System Utilization Management SUM Inpatient Denial RN + Oakland,...necessarily performed by each individual in the classification. 1. Review inpatient denials to determine root causes… more