Table of Content
Perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Support effective implementation of performance improvement initiatives. Facilitate communication between managed care/commercial payors and providers regarding benefit coverage issues, utilization review and quality assurance processes.
This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD and CPT coding systems and assists in decreasing the average accounts receivable days. As a Medical Economics Manager, you will provide consultative support and medical cost-based analysis of markets and network initiatives. You will be responsible for consulting with network and clinical management on opportunities to improve our...
Case Management Travel Nurse
Draft letters to send to members outlining benefits and other considerations.
Review inpatient and outpatient denial data and assist in the development of denial prevention interventions. Review retrospective denials and third-party audit denials that are determined to require write-off by corporate CM. Take active role in analyzing corporate CM reports and identifying opportunities for improvement, utilization trends within each institution and system-wide, and propose potential solutions to executive management to address issues as appropriate.
329 Work From Home Utilization Review Jobs
Analyze clinical service requests from members or providers against evidence based clinical guidelines. Responsible for screening inpatient admissions requests in the utilization management program. Adheres to policies and procedures in order to meet performance and compliance standards and to ensure cost effective and appropriate healthcare delivery... You can compare the number of available jobs in Ridgefield Park to the number of utilization review nurse jobs in surrounding cities. The remote physician advisor will perform clinical case reviews, ensure efficient services utilization, & give recommendations on levels of care.
We offer an array of exciting staffing assignments in facilities throughout New York City, New York State and beyond. Needs to review the security of your connection before proceeding. If so, please click "Applied for Job" to save it to your "Application History" page. If not, click on "Did Not Apply" to return to the job post.
Oncology Travel Nurse
Timely concurrent and retrospective appeals are a priority. Description Absolute Care offers concierge health services using a risk-bearing, PCP-driven care model. We treat the most clinically complex and vulnerable members of the communities we serve, many... Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connec...
Assesses, calculates and specifies the conditions under which the company is willing to accept risk on group life, disability and voluntary business for current and prospective clients. This includes, but is not limited to, the review and utilization... Provide specialized study support and assistance to clinical teams in the preparation and development of master and country-level clinical site budget templates utilizing industry benchmarking to ensure fair market value pricing.Perform budget review. We recommend you enter a location since many remote jobs have city, state or country requirements. If you re looking for a fulfilling career, then it s time to join the Crown Heights Center for Nursing and Rehabilitation team as an LPN.
Utilization Review Nurse Related Jobs
We are currently looking for a Licensed Practical Nurse who can complement our current Nursing Staff. If you re looking for a rewarding career in the healthcare industry, look no further than Seagate Nursing and Rehabilitation Center. For those who want to invent the future of health care, here's your opportunity. We're going beyond counseling services and verified referrals to behavioral health programs integrated across the en...
Responsible for authorizations for outpatient services or ancillary services in preparation... Manage document review projects to include project staffing, security, facilities, and technology needs. Ensure that reviews are completed on time and within budget utilizing qualified internal or vendor staff that is available, trained, and productive.
Utilize provider billing manuals to obtain billing guidelines and requirements. Special Handling billing included not limited to interim bills, overlap review, redistribution of money... Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual or MCG criteria. Participate in telephonic discussions with emergency department physicians relative to documentation and admission...
You'll be responsible for providing clinical review of cases using standard criteria to determine the medical appropriateness of inpatient and outpatient services while supporting our members through assessment, care and conservation. Analyze medical documentation to formulate a clear and concise clinically based argument to overturn denials. Exhibits clear and complete communication when documenting in company or client systems. Masters level degree in business and/or health care administration (i.e. MBA, MHA, MMM) preferred. Provide education on utilization management topics to the hospital medical staff.
Work collaboratively with a team of analysts and local market leaders. Analyze and research utilization and unit cost medical costs drivers. Turn data into usable information by telling the story through data visualization. Support the development of scoreable action items by identifying outlier cost issues. Support the peer-to-peer discussion process by communicating with external physicians and providers about denial determinations. Conduct verbal and written review and appeal of denied or downgraded coverage determinations made by managed care/commercial payors.
Review performance results, drug mix and utilization to identify opportunities to mitigate financial risk to the organization. Collaborate with underwriting, finance and accounting partners to... As a Senior Medical Economics Analyst, you will be providing consultative support and medical cost-based analysis of markets and network initiatives. As part of the Medical Expense Review team, you will work collaboratively with a team of... Ensure effective daily operation of the Utilization Management Dept utilizing all applicable statutory provisions, contracts and established policies and administrative procedures. Maintain optimal staffing patterns based on contractual obligations.
Licensed Practical Nurse (LPN)
Overseeing the quality of clinical care for network and non-network providers. The average utilization review nurse in Ridgefield Park, NJ earns between $58,000 and $105,000 annually. This compares to the national average utilization review nurse range of $47,000 to $89,000. At DRIFT, we work with healthcare companies across the United States to help recruit for frontline staff positions.
