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The Utilization Review RN Coordinates continuing care/outside services for value based risk members (HMO members) in collaboration with the hospital and primary care physician. As a part of the Utilization Management team the Utilization Review RN is a member of the Care Coordination team.
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An integrated EmPATH psychiatric patient space , super track/imaging/results lounge and improved connectivity and utilization of the ED observation unit. CMG offers an integrated healthcare system, including 4 hospitals, 70+ physician practices, including primary care, medical, and surgical specialists.
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What You'll Be Doing: As a Physician Clinical Reviewer, Interventional Pain Management, you will be a key member of the utilization management team. Physician Clinical Reviewer-Interventional Pain Management at Evolent Health in Boise, Idaho, United States Job Description Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions.
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Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care.
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Monogram Kidney Clinic is seeking a full-time palliative care physician to treat members with CKD and ESRD. Treatment and oversight will occur primarily through telehealth and locally in person.
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An Appeals Nurse Coordinator II will have experience with utilization management, DRG clinical validation, understand the state and federal regulations, have knowledge/experience with the denials and appeals process and have experience with physician documentation and electronic health records.
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Director Care Coordination- Major Responsibilities Criteria A: Establishes and coordinates communication with all Utilization Regulatory Agencies i.e. Qualidigm, NGS, etc., State and Third Party Payers to address Utilization Management Issues and Denials.
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Director Care Coordination- Major Responsibilites Criteria A: Establishes and coordinates communication with all Utilization Regulatory Agencies i.e. Qualidigm, NGS, etc., State and Third Party Payers to address Utilization Management Issues and Denials.
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Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, quality, innovation, and community, and its corporate culture supports those values wholeheartedly.
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Outstanding full-time support including physician(s), RNs, and x-ray tech. Utilization of EPIC EMR with Dragon. Led by physician-leaders who actively practice and understand both clinical and administrative aspects.
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Strong emphasis on physician wellness. Advanced diagnostic tools including MRI, CAT Scan, Ultrasound, Cath Lab, Anesthesia (in-house), and Nuclear Medicine with radiology reports available 24/7.
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Assists in compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction and quality indicators (e.g., readmission rates, unplanned return to OR, etc.
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The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. Minimum of two (2) years Utilization Management experience is preferred.
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The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services.
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The LVN case transition coordinator performs utilization review by using criteria that demonstrate medical necessity to achieve reimbursement for services and ensuring appropriate utilization of hospital resources.
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utilization physician jobs
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