- UCLA Health (Los Angeles, CA)
- …leader with: + Current CA LVN licensure required + Two or more years of utilization review / utilization management experience in an HMO, MSO, IPA, ... in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely...for appropriate care and setting while working closely with denial coordinators and other staff to ensure the accurate… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Inpatient Denial 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 Inpatient Denial ...and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of… more
- Baptist Memorial (Memphis, TN)
- …obtaining authorizations, claims review , patient billing, appeal writing, auditing, and/or denial management ; 3-5 years case management experience, or ... accredited nursing program Training Description Minimum Required Preferred/Desired Nursing, Case Management or Denial Management . Familiarity with electronic… more
- Baptist Memorial (Memphis, TN)
- …obtaining authorizations, claims review , patient billing, appeal writing, auditing, and/or denial management ; 3-5 years case management experience, or ... accredited nursing program Preferred/Desired Training Description Minimum Required: Nursing, Case Management or Denial Management . Familiarity with… more
- Cleveland Clinic (Cleveland, OH)
- …field + Current licensure as a Registered Nurse (RN) + Five years of Clinical Denial or Utilization Management experience + Expertise with InterQual and MCG ... Case Managers + Compile monthly quality audit reports for management + Provide feedback to the Clinical Denial...revenue enhancements. + Participate in the development of clinical denial policies and review of existing policies.… more
- Baylor Scott & White Health (Dallas, TX)
- …+ Worked on the payer (Insurance) side of appeals and denials. + Experience in Utilization Review and Case Management . **Essential Functions of the Role** + ... **Job Summary** You, as a Registered Nurse in the Denial Resource Center at Baylor Scott & White Health,...earnestly participating in their implementation. + By closely examining denial trends, you will categorize them based on impacts… more
- Sutter Health (Sacramento, CA)
- …EXPERIENCE:** * 8 years of recent relevant experience. * 2 years experience in Utilization Management (UM) and Clinical Denial Management Preferred ... System Office-Valley **Position Overview:** Manages the operations of the centralized Utilization review department for Sutter Health entities in accordance… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management ...they pertain to level of care determination and the appeal/ denial process. + Oversees utilization review… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management , and transitions of ... Criteria ( ie MCG, Xsolis) b. Supports & Participates in pre-admission review , utilization management , and concurrent and retrospective review… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management , and transitions of ... Criteria ( ie MCG, Xsolis) b. Supports & Participates in pre-admission review , utilization management , and concurrent and retrospective review… more