orientated medical chart reviews and other administrative tasks to meet the requirements of the medical center's utilization... of case management or utilization management experience. Knowledge of InterQual or McKesson criteria preferred. Knowledge...
cost and efficient use of medically appropriate services. Integrates and coordinates utilization management activities... transfers from UTMB TDCJ Hospital to specialty services hospitals. ESSENTIAL JOB FUNCTIONS: Utilization Management...
as needed to measure and trend performance indicators identified in the Utilization/Medical Management Plan. Ensures the management... of utilization management activities Oversees the management of observation cases, both concurrently and retrospectively...
Responsibilities This is a non-management job that will report to a supervisor, manager, director or executive. Minimum...- inpatient psychiatric experience. Psychiatric case management or utilization review experience preferred. Managed care...
between insurance companies and the treatment team. Notifies and alerts Director of Outpatient Services of potential utilization review...Job Description: Responsibilities ***Join Our Team as a Utilization Review Coordinator!*** North Spring...
authorizations, denials, escalations, and Medical Director reviews. Support quality improvement initiatives by tracking utilization... complex cases to the Medical Director. Stay updated on industry trends, regulatory changes, and best practices in utilization...
authorizations, denials, escalations, and Medical Director reviews. Support quality improvement initiatives by tracking utilization... complex cases to the Medical Director. Stay updated on industry trends, regulatory changes, and best practices in utilization...
of medical terminology, healthcare finances, alternative care options, utilization management, health plan criteria, established..., team lead and/or medical director to discuss requests/care inconsistent to criteria and determine the appropriateness...
between insurance companies and the treatment team. Notifies and alerts Director of Outpatient Services of potential utilization review...Job Description: Responsibilities ***Join Our Team as a Utilization Review Coordinator!*** North Spring...
, coordinates transitions of care to lower/higher levels of care, makes referrals for care management programs, and performs medical..., and retrospective review) for medical necessity referring to Medical Director as needed for additional expertise and review. Utilize...
will already possess management experience in a healthcare provider or medical insurance type role. Individuals with proven...Healthcare provider is currently hiring a permanent Utilization Manager for a full time position. This opportunity...
by utilization of avoidable day tracking in the electronic medical record. Develops and maintains professional relationships... case management/utilization review programs to maintain current knowledge of UR practices. Acts as a role model...
-surgical nursing experience Option 3: Three (3) years of utilization/case management or third-party payer experience Skills... license. Experience: Option 1: Three (3) years of critical care nursing experience Option 2: Five (5) years of medical...
. About the Job: Under the direction of the Director of Care Coordination, the Utilization Review RN (UR RN) is responsible... to obtain within a specified timeframe). Minimum of three (3) years of experience in hospital case management or utilization...
. About the Job: Under the direction of the Director of Care Coordination, the Utilization Review RN (UR RN) is responsible... to obtain within a specified timeframe). Minimum of three (3) years of experience in hospital case management or utilization...
for all patients. Role Description Utilization Review Manager (URM) reports to the Director of Utilization Review. The URM..., preferably related to clinical care, utilization review or case management. Master’s degree in social work or counseling...
Job Description: Responsibilities Director of Utilization Review (UR) and Case Management Located in South... or other community-based settings. The UR and Case Management Director assists admissions in screening patients at the pre-hospital...
Job Description: Responsibilities Director of Utilization Review (UR) and Case Management Located in South... or other community-based settings. The UR and Case Management Director assists admissions in screening patients at the pre-hospital...
utilization and referrals to Medical Resources. Reviews outpatient and urgent care consultations/referrals to determine... coordination with the Resource Management Committee (RMC) medical providers and team to maintain provider specific statistical data...
Job Summary and Responsibilities Under the general direction of the Director of Care Management, performs criteria-based... Shift Varies Weekly Schedule 08:00 am to 5:00pm varied days as needed Remote No Category Case Management and Social Work...