- CHRISTUS Health (Wake Village, TX)
- …patients entering the CHRISTUS Health system to ensure the appropriate utilization of resources and maximize appropriate reimbursement opportunities. They will ... of stay. * Coordinates with onsite partner providers (LTACH, Inpt Rehab) to review requests for facility services and ensure appropriate use of outpatient hospital… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: This Utilization Review Denials Review Unit (DRU) 3 Team Lead will assist the Director of Utilization Review and the Associate ... Director of Utilization Review with daily staff mentoring, leadership and resource provision....and provides feedback/mentorship to UR CR I as to review , payor and regulatory questions. This UR DRU 3… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …+ 5 years of RN experience preferred. + Minimum Three (3) years utilization management experience preferred + Denials management experience preferred. + Care ... vacation, adoption assistance, annual bonus eligibility, and more! **Responsibilities** The Denials RN is responsible and accountable for receiving, processing and… more
- Dayton Children's Hospital (Dayton, OH)
- Facility:Work From Home - OhioDepartment: Utilization Review TeamSchedule:Full timeHours:40Job Details:Reporting to the Manager of Utilization Management and ... Management; supports the development and implementation of a comprehensive denials management program. This role functions as a hospital...in a hospital required + 3-5 years as progressive utilization review nurse and knowledge of payers… more
- CommonSpirit Health (Sacramento, CA)
- …community. **Responsibilities** **This is a remote position.** **Summary** The Utilization Management Physician Advisor II conducts clinical case reviews referred ... for assuring quality patient care and effective and efficient utilization of health care services. This position will be...This position will be a part of the specialized Denials Management team. This individual meets with case management… more
- Insight Global (Skokie, IL)
- …. Skills and Requirements 3+ years experience as a utilization review nurse Experience reviewing and analyzing denied ... As a Clinical Denials Specialist you will be working with the denials team to review and analyze denials from a clinical perspective. This person will be… more
- Kaleida Health (Buffalo, NY)
- …conventions and insurance / managed care practices including but not limited to: utilization review , RAC, MAC, Q10, clinical and DRG denial management required. ... Revenue Cycle Admin **Job Description:** The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to the Clinical Revenue… more
- Kaleida Health (Buffalo, NY)
- …of applications utilized to support Health information management (HIM), DRG Denials and Clinical Documentation (CDI). This position designs, implements, and ... 3M HDM, 3M 360 CAC, RCW, Coding Pre Bill review software and Eclipsys and will be a vital...implement, and monitor the HIM Coding Team, DRG and Utilization Management Clinical Denial teams. **Buffalo,NY** **Location:** Larkin Bldg… more
- Prime Healthcare (Reno, NV)
- …with the ongoing education/training to stay current with emerging industry trends on utilization review and denials management. Performs ongoing audits, to ... of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities Utilization Review Manager is responsible for the… 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 ... population and Hackensack UMC. These include but are not limited to utilization review ,** **hospital reimbursement, clinical compliance, case management, and… more
