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Utilization Review Specialist Job DescriptionUnique opportunity to join Maryhaven, Central Ohio’s largest and most comprehensive behavioral services provider specializing in addiction recovery.
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In collaboration with providers and the Medical Director, the Utilization Review Nurse ensures medical appropriateness and effective utilization of health care resources. The Utilization Review Nurse ensures that authorization requests and provider or member inquiries are handled appropriately within established timeframes, and established guidelines and protocols are utilized for clinical decision-making.
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Minimum of 3-5 years nursing experience and knowledge of the utilization review process. Partners and collaborates with provider partners on Utilization Review processes. Provides orientation of other Utilization Review Nurses as requested.
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Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
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The Utilization Review Specialist at Mount Carmel Behavioral Health, a joint partnership between Acadia Healthcare and Mount Carmel Health Systems, will serve as a partner to the UM department and other departments through the facility as a bridge between impacting direct patient care and financial stability of the facility.
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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.
Part-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Participates on the Institutional Biosafety Committee (IBC), include the review of protocols. Participates on the Institutional Animal Care and Use Committee (IACUC), include the review of protocols.
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Designs and constructs templates and fixtures for utilization in sheet metal fabrication. Utilization of overhead crane and slings to transport dies. May require utilization of blueprints and/or other operational documentation.
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The Reimbursement Manager will also work on patient level reimbursement issue resolution, and thus will need access to be knowledge of and have had experience with patient health information (PHI), navigating access issues, and working with payer and NCCN guidelines for product utilization.
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This role involves leading a team in various credit risk review engagements and continuous monitoring activities associated with a strong independent credit review and/or similar credit risk management function.
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The Quality Assurance Associate/Specialist responsibilities include, but are not limited to; controlled documentation issuance, batch record review, verification of manufacturing activities (including operations within aseptic areas), standard operating procedure creation and review, investigations, and implementing corrective and preventive actions.
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The ICE Clinical Specialist (ICS) is accountable to provide technical and clinical product support to health care providers and laboratory staff for diagnostic catheters and ultrasound systems – with an emphasis on Structural Heart and the ACUSON AcuNav Volume ICE catheter utilization.
$102,000 - $130,000 a yearFull-timeExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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Ensures organs and tissue will be recovered and preserved to maximize utilization in accordance with Lifeline of Ohio and OPTN/UNOS policies. Will review the documentation on donor cases in real time for the accuracy of the following but not limited to; brain death documentation, ABO & ABO Subtyping, serologies, hemodilution, COVID testing and other OPTN documentation requirements.
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The Utilization Review Specialist is an essential role at Mount Carmel Behavioral Health, an 80-bed inpatient acute treatment center for adult men and women who have been/currently are experiencing a wide range of mental or behavioral health challenges.
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Post-Production: Collaborate with our motion graphics designers to review footage, provide feedback, and guide the editing process. Video Production Manager. Production Planning: Coordinate all aspects of production, including location scouting, permitting (as needed), casting, crew hiring, equipment rental, and scheduling.
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utilization review jobs Company: Elevance Health in Columbus, Bar-harbor, Maine
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