- University of New Mexico - Hospitals (Albuquerque, NM)
- …Position Summary: Coordinates, monitors, promotes and evaluates, in collaboration with the Trauma Medical Director the clinical aspects of the Trauma program to ... and reviewing potential outliers in collaboration with the Trauma Medical Director . These activities include but are... DOCUMENTATION - Identifies the need to clarify documentation in medical records and initiate communication… more
- Comhar Inc. (Philadelphia, PA)
- …this individual supervision a chart review should be completed using the updated Utilization Review sheet with particular attention paid to whether or not a PGP ... that the staff under their supervision are making every attempt to complete the documentation in a timely fashion and that it meets the general guidelines of… more
- Comhar Inc. (Philadelphia, PA)
- …this individual supervision a chart review should be completed using the updated Utilization Review sheet with particular attention paid to whether or not a PGP ... that the staff under their supervision are making every attempt to complete the documentation in a timely fashion and that it meets the general guidelines of… more
- Trinity Health (Boise, ID)
- …Saint Alphonsus is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This position will be ... annually by the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is the lead provider for… more
- Universal Health Services (Streamwood, IL)
- Responsibilities Director of Utilization Management Full-Time The Director of Utilization Management is responsible for the oversight of the ... utilization management department. Responsibilities include monitoring team members to...with several departments including Physicians, Nursing, and Therapist on documentation and importance of Medical Necessity. Help… more
- Albany Medical Center (Albany, NY)
- …actions to achieve continuous improvement in both areas.* Refers cases and issues to Medical Director and Triad Team in compliance with Department procedures and ... and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation ...Care Plans Thank you for your interest in Albany Medical Center! Albany Medical is an equal… more
- Albany Medical Center (Albany, NY)
- …actions to achieve continuous improvement in both areas.* Refers cases and issues to Medical Director and Triad Team in compliance with Department procedures and ... and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation ...care team Thank you for your interest in Albany Medical Center! Albany Medical is an equal… more
- Mirror (Newton, KS)
- Job Summary: Under the administrative supervision of the Director of Utilization Management, the URC is responsible for the implementation, and maintenance of ... federal regulations and departmental guidelines. + Other duties as requested by the Director of Utilization Management. Qualifications + High School diploma or… more
- WellSpan Health (York, PA)
- …hospitalization and initiates problem-solving techniques as needed to prevent over and/or under utilization . Refer cases to Medical Director that require ... Utilization Management Nurse (RN) - Case Management -...and Responsibilities Essential Functions: + Performs initial reviews for medical necessity and appropriateness of setting for the assigned… more
- Guthrie (Sayre, PA)
- …as necessary with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as appropriate. a) Serves ... coding, medical record or chart auditing, and experience in utilization management processes preferred. Knowledge of computer applications (such as Microsoft… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day operations of… more
- State of Indiana (Indianapolis, IN)
- …* Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise. * Review clinical ... Utilization Review Coordinator Date Posted: May 31, 2024...for ensuring the delivery of high quality, cost efficient medical outcomes for patients in need of inpatient and/or… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …other assigned duties to meet required turnaround times. + Prepares and presents cases to Medical Director (MD) for medical director oversight and ... Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews. This position… more
- Dignity Health (Rancho Cordova, CA)
- …review a referral. Fosters the relationship between the Pre-Authorization team and the Medical Director and Physician Reviewers. - Tracks cost savings from ... home.** **Position Summary:** Under the guidance and supervision of the department Manager/ Director , the Supervisor of Utilization Management is responsible and… more
- Martin's Point Health Care (Portland, ME)
- …prior authorization requests (prior authorization, concurrent review, and retrospective review) for medical necessity referring to Medical Director as needed ... support accurate medical necessity and dispute decisions. + Partners with Medical Directors, Utilization Review Team, Provider Inquiry, and Claims regarding… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …other assigned duties to meet required turnaround times. * Prepares and presents cases to Medical Director (MD) for medical director oversight and ... Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity reviews… more
- Martin's Point Health Care (Portland, ME)
- …prior authorization requests (prior authorization, concurrent review, and retrospective review) for medical necessity referring to Medical Director as needed ... to Work" since 2015. Position Summary Job Description The Utilization Review Nurse works as a member of a...for ensuring the receipt of high quality, cost efficient medical outcomes for those enrollees with a need for… more
- Providence (Everett, WA)
- **Description** ** Utilization Management Assistant (279237)** **Schedule: FTE 1.0, Monday-Friday 08:00AM - 4:30PM PST (8HR SHIFT), Day** The primary responsibility ... of the position is to maintain standard compliance and performance related utilization management data. Process of daily, weekly and monthly UM reports. Establishes… more
- Acacia Network (Bronx, NY)
- …care plan (interdisciplinary) team, identifying and referring requests for services to the Medical Director when guidelines are not met and reviewing residential ... Acacia Network Inc. Utilization Manager Bronx, : 5/30/2024 Job Description Job...from third party payers at pre-admission through discharge, ongoing medical necessity reviews and interdisciplinary team support with respect… more
- AdventHealth (Maitland, FL)
- …Site position** **The role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle educates, informs, and advises members ... related to denial prevention measures for our contracted managed care payers. The Medical Director is responsible for providing physician review of … more
