- Beth Israel Lahey Health (Plymouth, MA)
- …team, you're not just taking a job, you're making a difference in people's lives.** MANAGER , UTILIZATION REVIEW & DENIALS MGMT **Job Description:** Beth ... of care determination and the appeal/denial process. + Oversees utilization review workflow processes to ensure timely...review workflow processes to ensure timely response to denials . + Maintains a database to track level of… more
- HCA Healthcare (Nashville, TN)
- …with NCBON. **Preferred Certification:** Nationally accepted certification in Case Management, Utilization Review , Coding, or other denial management practices ... Work from Home team is looking for a Remote Manager Division Denials . HCA Healthcare is an...denial management. + Requires professional level of knowledge of utilization review , care management, InterQual and/or medical… more
- Catholic Health Initiatives (Omaha, NE)
- …+ 5 years of RN experience preferred. + Minimum Three (3) years utilization management experience preferred + Denials management experience preferred. + Care ... **Overview** The Denials RN is responsible for managing all concurrent...appropriate admit status for concurrently denied hospital stays, using utilization management guidelines, medical necessity criteria, critical thinking skills,… more
- Prime Healthcare (Elgin, IL)
- …with the ongoing education/training to stay current with emerging industry trends on utilization review and denials management in addition to maintaining ... coding staff and hospital management staff. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/179182/regional- utilization - review - manager /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilitySaint Joseph Hospital -… more
- LifePoint Health (Brentwood, TN)
- …secure approval for business cases to support comprehensive programs to prevent payer denials . * Implement centralized utilization review and authorization ... of clinical experience in an acute care setting managing utilization review , medical necessity and denials...with American Case Management (ACM) or Commission for Case Manager (CCM) preferred. * Licenses:*Current licensure as a Registered… more
- Dignity Health (Redwood City, CA)
- …+ _Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted ... for appropriate status determination._ + _Ensures compliance with principles of utilization review , hospital policies and external regulatory agencies, Peer… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of ... Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case...documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the ... Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case...documentation e. Target DRGs Reviews f. Use of case manager as a resource + Uses guidelines to evaluate… more
- Community Health Systems (Franklin, TN)
- …appropriate additional documentation from the physician(s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if physicians ... of medical services and procedures in the hospital setting. Utilization review is the assessment for medical...in such a way that minimizes the risk of denials after discharge. The hours for this position will… more
- Behavioral Center of Michigan (Warren, MI)
- …skills to help educate the staff and physicians regarding charting. REPORTS TO: Utilization Review Lead/ Manager QUALIFICATIONS: + High School Diploma or ... those duties include all tasks requested by the UR Manager , CEO or Medical Director to meet the needs...denials . Responds to complaints per UR guidelines. Maintains utilization review and appeal logs, as needed.… more