- UpvoteDownvoteShare Job
- Suggest Revision
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Participates in utilization review, quality assessment and improvement programs to improve patient care. Collaborates with Radiology, Pathology, Surgery, Medical Oncology, and Nursing in the clinical management of patients.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Working knowledge of the RN scope of practice current state requirements CMS Conditions of Participation EMTALA Patient Bill of Rights AB1203 CCS guidelines and other federal or state regulatory requirements as specific to Utilization Review and Discharge Planning required Certification appropriate for the position preferred (CCM ABQAURP or ACM) Bilingual skills helpful.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
8 - Participates in the utilization review process in the collection and analysis of data related to medical care. Coordinates with other departments which interface with the critical care units, most notably the Department of Emergency Medicine, Department of Surgery, Department of Medicine; and coordinates with the Operating room ensuring that patient care is seamless and has continuity on transfers and when procedures are involved; works closely with Respiratory Medicine and Anesthesiology in optimizing patient welfare.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
As a Cardiology, Physician Clinical Reviewer you will be a key member of the utilization management team. Serve as the specialty match reviewer in Spine Surgery cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Knowledge of insurance, utilization review, scheduling requirements and support of front desk responsibilities. Follows policy and procedure for entering of OCM and utilization of IDX. Completes work within assigned hours.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Five years of acute care nursing including medicine/surgery, ICU, telemetry or Five years of Case Management experience in an acute setting or utilization review at a medical group or health plan.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Preferred Licenses/Certifications: Certification in Case Management, CCMC or ACM. Required Education: Bachelor's of Nursing, Required Experience: Five years of acute care nursing including medicine/surgery, ICU, telemetry or Five years of Case Management experience in an acute setting or utilization review at a medical group or health plan.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
The Southwest Healthcare Regional office in Temecula, CA is seeking Two (2) Per Diem LVN Central Utilization Review Nurses who will be responsible for carrying out utilization management functions by planning, coordinating, and managing patient needs during hospitalization and throughout the continuum of care.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Major responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness of services as well as appropriate utilization of services; and ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements.
$49.66 - $65.8 an hourPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
JOB SUMMARYThe RN Utilization Review coordinates care for OPIS patients who are high cost, complex, and at risk. NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Experience in case management field including utilization review, discharge planning, outcomes management, assessment care planning and care coordination, related experience or training preferred.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Review medical records for knowledge/understanding of situation and resource assessment. Monitor costs, avoidable treatments and resource utilization. Maintains understanding of various payers and Medicare pre-authorization processes.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Serves as a liaison between hospital and payer to obtain pre-authorization confirmation and enters into medical record/billing system timely and accurately. Communicates with physicians to ensure that correct clinical data is documented to gain proper pre-authorization for third party payers.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Understands the legal/regulatory requirements related to the release of information. Licensed as a Registered Nurse (RN) in the State of Florida · Minimum of 1 year of experience in a related field required.
Full-timeExpandApply NowActive JobUpdated Today
utilization review surgery jobs
FEATURED BLOG POSTS
How Does Salary Pay Work? (Compared to Hourly Pay)
At the bottom of each job advertisement, companies label a role as salaried or hourly. Both methods will get you paid (yay), but each in very different ways. So, it's essential to figure out how does salary pay work? While employees paid by the hour are paid based on how long they work, employers pay salaried employees a fixed amount.
The Quiet Quitting Phenomenon
The term, quiet quitting, was coined in 2009, but only now is it gaining traction as young Millennials and Gen Z workers are experiencing record levels of burnout. With the pandemic and the state of the economy, young employees are feeling the pressure. So, quiet quitting comes into effect when that pressure is exasperated by work stress and no managerial support.
How Does Salary Range Work (With Examples)
What are your salary expectations? Do you know? Establishing a salary that compensates you fairly and keeps you happy at work can feel like taking a shot in the dark. And employers sure don’t make learning budgets easy!
Guide to Hiring a Teenager
Teenagers are full of life. They bring energy and adaptability that may be hard to get from older workers, but does that mean that hiring teens is beneficial? Well, it depends. As you debate whether or not you should integrate teenagers into your workforce, there are some things that you should know first.
How to Re-apply for Your Old Job Professionally
Have you recently started a new job only to find that you miss your old one? Maybe you didn’t realize how good you had it, and now you regret leaving. Don’t worry. You’re not the first person to feel this way, and you might even be able to return to your old job if you play your cards right.
5 Practical Ways to Remove Bias from your Hiring Process
Many employers think their hiring process is perfect. However, research shows that the hiring processes are generally impartial and unfair, especially if you are part of certain demographics. Women, people of color, people with disabilities, or even people in lower socioeconomic status are more likely to be subject to implicit bias. As diversity and employer branding become major aspects of business, it is important that employers take the lead to identify and remove bias from the hiring process. So, here are 5 practical ways to get you started.
Tips for a Good Character Reference Letter with Examples
Hiring managers love a resume laden with relevant skills and qualifications. Hard skills specific to the role, like SEO strategy or Java programming languages, are easy to qualify using achievements or facts and figures. But how exactly can they verify personality traits, work ethic, relationship management skills, or curious nature during an interview when they barely know you?