- 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
- 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)
- *Description* Summary: The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary team, and organization with the underlying ... of care and providing timely and accurate clinical information to payors. Utilization management provides clinically based first level medical necessity reviews by… 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
- Intermountain Health (Murray, UT)
- …regulatory requirements. + Occasional travel to provider locations within Select Health region. ** Utilization Review and Care Management:** + ** Review and ... expertise of a Licensed and Masters Prepared Behavior Health Specialist with Utilization and Care management. This...in behavioral health. + Knowledge of healthcare insurance and utilization review processes. + Excellent communication and… 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
- New York State Civil Service (Brooklyn, NY)
- …Agency Mental Health, Office of Title Mental Hygiene Program Evaluation Specialist 3 (NY HELPS), Kingsboro Psychiatric Center, P25770 Occupational Category Health ... Class Travel Percentage 0% Workweek Mon-Fri Hours Per Week 40 Workday From 6 AM To 6 PM Flextime...Center is currently recruiting a Mental Hygiene Program Evaluation Specialist 3 to join their program evaluation department which… more