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The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed. Three to Five (5) years experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, or Utilization Review Coordinator.
$48,000 - $52,000 a yearRemoteExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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The Utilization review specialist will use internal audit tools to continually review BH programs, provide targeted support to assigned programs, identify areas needing improvement, and help ensure program compliance with all state/federal/CIHA/Joint Commission regulations.
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Utilization Review RN - remote position. Understand how utilization management and case management programs integrate. Dignity Health Mercy San Juan Medical Center is a 370-bed not-for-profit Level 2 Trauma Center located in Carmichael California serving the areas of north Sacramento County and south Placer County for more than 50 years.
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Preferred:-Leadership experience in a utilization management clinical operations business inside a health plan or a UM/benefits management firm-Utilization management or clinical experience with post-acute care, especially home health and DME-Experience managing productivity with operational tools such as WFM software, Excel, Tableau, Smartsheet, dashboard and report-buildingFor candidates working in person or remotely in the below locations, the salary.
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Ensure effective utilization and optimization of the Epic Tapestry system to support managed care operations and population health management. Epic certification in one of the following Tapestry modules: AP Claims and Contracts, Enrollment and Eligibility, Referrals and Authorization, Utilization Management.
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Ultimately, the Client Success Manager will take the Get Well program to the next level by driving nurse engagement, focusing on increased utilization, and leading projects of functionality to drive outcomes.
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With TPMG partner, directs development and implementation of quality and utilization standards across the continuum of care to ensure coordinated plans of treatment, patient focused delivery of services and cost effective utilization of necessary services.
$191,000 - $247,060 a yearExpandUpdated 11 days ago - UpvoteDownvoteShare Job
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Please rate your hands-on experience with the following from 1-5: managing commercial GEOINT utilization, tradecraft, and architecture advancement, across the National System for Geospatial Intelligence (NSG), the Allied System for Geospatial Intelligence (ASG) and across third-party partnerships.
$80,000 - $85,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Demonstrates knowledge of utilization review and collaborates with the Utilization Management Specialists to insure the ongoing, comprehensive monitoring and evaluation of patient care, by concurrent and retrospective review to assure appropriate reimbursement.
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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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Examples of qualifying law enforcement experience include conducting criminal investigations involving federal tax and/or money laundering violations including one or more of the following: Indirect methods of proof; utilization of multiple nominees, bank accounts, and/or entities; utilization of alter ego and/or sham corporations; multiple judicial districts and/or targets; and/or other financial investigations (money laundering.
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Interact with insurance companies for pre-certification and utilization management. ounselor, social worker, marrage and family therapist, inpatient, counseling, therapy, LMHC, registered, behavioral health professional, LPCC, LPC, LMFT, MFT, QMHA,licensed.
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Provide statistical reports to the Health & Wellness Manager regarding program utilization. Establish opportunities to coordinate with the Wellness Coordinator on the OSU Tulsa campus to deliver fitness programs and intramural sports opportunities.
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The Clinical Care Coordinator will play a vital role in overseeing Case Management, Utilization Review, and Infection Preventionist functions within this small hospital. Experience in Case Management, Utilization Review, and Infection Preventionist roles within a healthcare setting.
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Experience in leadership and oversight of segment leaders and strategic direction of clinical, quality, and population health programs across care management, utilization management, quality, and value based care.
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utilization job
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