9 utilization review specialist senior jobs found

Utilization Review Specialist Senior ( Job Number: 231283 ) Description The Senior Utilization Review Specialist functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services. Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials. Preferred experience includes Critical Care or Emergency Nursing RN. Qualifications Certifications and Licensures Required RN (Registered Nurse) Preferred ACM (Case Management) Preferred CCM (Case Manager) Education Required Associate's Nursing Or Bachelor's Nursing Preferred Master's Nursing Or Master's Business Experience Required 2 years Utilization Review Or 2 years Case Management...

Utilization Review Specialist Senior ( Job Number: 213966 ) Description The Senior Utilization Review Specialist functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services. Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials. Preferred experience includes Critical Care or Emergency Nursing RN. The schedule is working 3 weekend days in a 2 week period - 36 hours per 2 week pay period. Qualifications Certifications and Licensures Required RN (Registered Nurse) Preferred ACM (Case Management) Preferred CCM (Case Manager) Education Required Associate's Nursing Or Bachelor's Nursing Preferred Master's Nursing Or Master's...

Utilization Review Specialist Senior ( Job Number: 226632 ) Description Sign On Bonus Available, Weekend hours are Saturday and Sunday BayCare Health System is currently in search of our newest Team Member who is passionate about providing outstanding customer service to our community at Morton Plant Hospital. In 2019, Morton Plant Hospital continues to be a leader in its field, having been nationally recognized by IBM Watson Health as one of the Top 100 Hospitals in the country for the 7th time. The 599-bed facility provides highly technical and specialized care to more than 50,000 patients annually and works in more than 50 specialty areas. The Utilization Review Specialist Senior responsibilities include: Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient...

Utilization Review Specialist Senior ( Job Number: 232570 ) Description BayCare Health System is currently in search of our newest Utilization Review Specialist Senio r who is passionate about providing outstanding customer service to our community at Mease Countryside Hospital. Since 1985, Mease Countryside Hospital has been raising the standard of care for patients of all ages. Today, our 387-bed facility offers an unwavering commitment to the community. Liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services. Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials. Preferred experience includes Critical Care or Emergency Nursing RN. Why BayCare? Our...

Utilization Review Specialist Senior ( Job Number: 232321 ) Description BayCare Health System is currently in search of our newest Utilization Review Specialist Senio r who is passionate about providing outstanding customer service to our community at North Bay Hospital. Morton Plant North Bay Hospital is West Pasco County’s only not-for-profit community hospital and has 120 acute care beds. Nationally recognized for health care excellence, we have achieved Primary Stroke Center recertification by The Joint Commission, meaning our stroke care protocols meet the standards of the country's best programs.  Liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services. Perform other duties as assigned by the supervisor including but not...

Utilization Review Specialist Senior ( Job Number: 232319 ) Description BayCare Health System is currently in search of our newest Utilization Review Specialist Senio r who is passionate about providing outstanding customer service to our community at Mease Countryside Hospital. Since 1985, Mease Countryside Hospital has been raising the standard of care for patients of all ages. Today, our 387-bed facility offers an unwavering commitment to the community.       Liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services. Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials. Preferred experience includes Critical Care or Emergency Nursing RN. Why BayCare? Our network...

Care Manager (RN), PRN Division Emory Johns Creek Campus Location Johns Creek, GA, 30097 Campus Location US-GA-Johns Creek Department EJC Social Services Job Type PRN / Registry Job Number 106427 Job Category Nursing Schedule 8:30a-5p Standard Hours 4 Hours Description The shift for this PRN position is 8:30a-5p   JOB DESCRIPTION: Responsible for coordinating clinically complex patients' care across a continuum; ensuring and facilitating the achievement of quality clinical and cost outcomes; negotiating, procuring and coordinating appropriate services and resources needed by the patients; and at key points, intervening to address and resolve barriers to timely and efficient care delivery and reimbursement. Communicates confidently and effectively with all levels of hospital staff, physicians and payors; Is assertive without being overly aggressive; Conveys an impression which reflects favorably upon the public relations of the organization. Reinforces and ensures appropriate...

Overview Atrium Health Mercy, a facility of Carolinas Medical Center, is one of two CMC locations and is 1.3 miles from CMC. For more than 100 years, Atrium Health Mercy has treated patients with a special combination of human compassion and leading-edge medical expertise. Atrium HealthMercy is a full-service community hospital, specializing in the care of seniors and in complex foot and ankle surgery, hip and knee surgery, bariatric surgery and women’s pelvic health. Job Summary Facilitates a lifelong, proactive partnership with patients to enhance and personalize management of health-related needs. The Care Manager assesses needs, plans, coordinates, and evaluates services of patients with the goal of equipping and empowering individuals and their families to easily access resources and adopt healthy lifestyles that will increase their ability to remain in the most appropriate care setting. Care Managers focus on five primary areas: 1) population management,...

Utilization Review Specialist Sr ( Job Number: 232934 ) Description BayCare Health System is currently in search of our newest Utilization Review Specialist Senio r-ED who is passionate about providing outstanding customer service to our community at St. Anthony's. St. Anthony's has a long tradition of providing a wide range of exceptional health care services to our community — more than 85 years of advancing superior health care.    Liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services. Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials. Preferred experience includes Critical Care or Emergency Nursing RN. Why BayCare? Our network consists...