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This leader plans, organizes, directs, and evaluates resource and quality management services, departments, and programs, such as Quality Assurance, Utilization Review, Infection Control, Case Management, and Admissions.
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Review of investment portfolio activity in the PAM for Investments (PFI) system, the investment datamart and utilization of DIGITS reporting tool. PFI, Essbase, & BlackLine experience preferred.
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Knowledge of legislative/oversight bodies (e.g., URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQNational Committee for Quality Assurance, and ERISEmployee Retirement Income Security Act of 1974.
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When deemed necessary and appropriate within a market, the Dental Director will focus on the proper provision of medically necessary covered services for enrollees and remain closely involved in the monitoring of program integrity, quality, utilization management, and utilization review.
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Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation.
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Utilize customer relationship management software (CRM) and other tools to review activities, drive utilization and provide feedback to achieve optimal sales performance and productivity.
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Utilization review activities in an accurate and timely manner for the purpose of providing. Maintains current knowledge of Utilization Review Methodology, software, criteria, and regulations governing various payment systems.
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Carries out hospital programs and principles of utilization review in compliance with hospital policies and external regulatory agencies Peer Review Organization (PRO), The Joint Commission (TJC, and multiple payer defined criteria for eligibility.
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Collaborate and coordinate with marketing to develop programs, promotions, collateral materials, and sales tools, implementing a regular cadence of promotions that drive incremental sales. Provide dynamic leadership to build, coach, develop, manage and evaluate high performance teams capable of carrying out sales, business development, customer service, and other initiatives.
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Some of the most important skills include patience, excellent communication, ICD coding, critical thinking, utilization review and stress management. Specialty: Emergency room, oncology, intensive care, psychiatry, telemetry, labor, and delivery, etc.
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Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers compensation claims.
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Dane Street is an Independent Review Organization and a national provider of Utilization Review services (among other offerings) and we are expanding our physician panel resulting in opportunities for non-traditional physician work and supplemental income.
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EzURS.com Inc., has an ongoing need for Physician Consultants to perform a wide variety of world-class utilization review, disability, peer reviews products in multiple lines of business including health, workers compensation, and auto liability.
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TRS Healthcare is seeking a travel nurse RN Utilization Review for a travel nursing job in Olney, Maryland. Posted job title: Utilization Review Registered Nurse About TRS Healthcare TRS Healthcare has been a leader in the healthcare staffing industry for over 25 years, providing exceptional career opportunities for healthcare professionals nationwide and supplying healthcare organizations with comprehensive staffing and placement solutions to meet a wide range of workforce recruitment needs.
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Responsible for overseeing and coordinating all clinical aspects of the health plan, including medical and pharmacy management, utilization review, and initiatives to ensure care and services provided align with evidence-based guidelines and best practices.
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utilization review jobs in Urbandale, IA
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