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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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The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed. Job Overview: The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies.
$48,000 - $52,000 a yearRemoteExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Utilization Review RN - remote position. Understand how utilization management and case management programs integrate. The incumbent is responsible for the review of medical records for appropriate admission status and continued hospitalization.
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Amity Foundation an internationally acclaimed teaching, and therapeutic community is seeking compassionate and enthusiastic individuals with a desire to teach, learn and join our community as a Utilization Review Specialist at our campus in Tucson, AZ. With this groundbreaking opportunity not only will you be working with our home offices, but you will also be enhancing your training and experience in the field and supporting the growth of our community.
$15 - $18 an hourFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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UTILIZATION REVIEW / CASE MANAGEMENT RN - Part Time, Weekends. Position Summary: Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information.
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2 holidays per year required and weekend rotation Hospital: Ascension St. Agnes Location: Baltimore, MD We offer free parking to all associates Seeking experienced Utilization Review nurse.
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As a Denials Coding Review Specialist , you will be responsible for applying correct coding guidelines and payor requirements as it relates to researching, analyzing, and resolving outstanding clinical denials and insurance claims.
Full-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Experience using Jack Henry/Silverlake, Global Wave Portfolio Track and DiCOM Loan Review software preferred, but not required. Experience:A minimum of three (3) years of commercial credit experience and five (5) years of combined commercial lending, commercial credit, special assets, and/or loan review experience required.
$58,500 - $88,000 a yearFull-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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A minimum of three (3) years of commercial credit experience and five (5) years of combined commercial lending, commercial credit, special assets, and/or loan review experience required. Perform various duties relating to the loan review function in order to assist in the ongoing management of credit risk as follows: Conduct thorough credit reviews to analyze adherence to loan policy and procedure, credit quality, collateral valuation, accuracy of core operating system as it relates to loan structure/pricing, and loan documentation.
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Ensures consistent application of the utilization review process for effective utilization of resources. Identify when services that are not medically necessary and/or not covered benefit and refer to Utilization Review Committee.
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Must have hands-on familiarity with a variety of computer applications, including word processing, databases (such as document review and file management systems), spreadsheets, and imaging. Obtains needed information from case files, law enforcement agencies, civil client agencies, or other sources, and submits completed legal documents to the appropriate client assistant attorney for review and approval.
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A minimum of five (5) years of commercial credit experience and ten (10) years of combined commercial lending, commercial credit, special assets, and/or loan review experience required. Responsible for performing a variety of duties relating to the loan review function in order to assist in the ongoing management of credit risk; achieving goals as established in the department's annual review schedule; complying with operating policies and procedures established for the loan review function; communicating with appropriate personnel; responding to inquiries and requests for information; maintaining appropriate records and providing reports.
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Must have 2 years working in a hospital and 2 years of utilization review (UR) experience in a hospital or insurance company. Uses clinical and analytical skills to review and interpret diagnostic test results to determine appropriateness of patient's level of care.
$68,224 - $104,811.2 a year depends on experienceFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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The Manager, Customer Success Utilization reports to the Surgical Sales Executive Director. Create a post install feedback loop between the Utilization Customer Success Manager and the Customer, audit delivery.
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The Operational Risk Review (ORR) Testing Analyst -Technology ("Analyst") is responsible for the execution of testing activities within Independent Risk Review Assessment (IRRA), a centralized second line independent testing function.
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Title: utilization review specialist Company: Waukegan Hospital
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