better Utilization Reviewer Job

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Description: North Star is Alaska s premier behavioral health provider that specialized in helping young people with life s challenges. We recognize that child hood should be a time of joy, fulfillment, growth, and nurturing care. We also recognize that situations happen that are beyond young people s control or ability to effectively handle. Our programs at North Star work with the family and the community to help facilitate o ptimal growth and nurturing throughout times of childhood adversity

Gracie Square Hospital New York City's preeminent provider of inpatient managed behavioral health services has the following opportunity: UTILIZATION REVIEW COORDINATOR FULL TIME POSITION Serves as liaison between Hospital and insurance providers to ensure financial coverage for patients. Responsibilities include pre-certification, concurrent reviews, documentation and appeals. Must have working knowledge of managed care principles, utilization management, healthcare contracts and eligibility requirements. Must

2 years experience with Utilization Review or Case Management Will also consider candidates with 5...2 years experience with Utilization Review or Case Management Will also consider candidates with 5...

time management organizational competency and value added case management...Thorough knowledge of Beacon s level of care criteria and case management protocols 7...

Review medical records evaluate level of care interact with physicians case managers discharge planning...Collect case specific member information review and certify the...Review each case and determine the most appropriate services the...

Works closely with the Medical Director Case Management and care facilities to facilitate transitions...

This position is responsible for the pre -certification and benefit verification for medical services to ensure prompt and accurate payments from insurance company. Collections of deposits on services in a prepayment capacity. Handles personal injury lines of business. Identifies and corrects internal problems within assigned accounts to expedite payments from insurance companies. Serves as liaison between patient and insurance companies. Performs month-end closing on routine schedule with other patient account

May perform review of cases to identify referral for case management...

COMPANY PROFILE The Devereux Foundation is the largest nonprofit provider of behavioral healthcare in the country for individuals with developmental/intellectual disabilities, behavioral challenges and mental illness. Devereux has 15 centers operating in 11 states across the nation. We have been around since 1912 and employ close to 6,000 staff members at all levels that provide professional and quality care to more than 15,000 individuals annually. THE DEVEREUX WHITLOCK CENTER Established

excellent opportunities for experienced Acute Care RN Case Managers Responsible for implementing the utilization management...Communicates the plan of care to various Case Managers with focus on information received related...care nursing experience Completion of Utilization Review Case Management course Required Certification American Heart Association...

Utilization Review Nurse / RN / Registered Nurse Applied Underwriters is searching for a Utilization Review Nurse to perform of day-to-day Utilization Management activities related to workers compensation, including, but not limited to, review of clinical information to determine medical necessity at all levels of care utilizing criteria- or evidence-based guidelines, interacting with physicians, claimants and peer reviewers as part of the Utilization Management process. Applied Underwriters is setting the

May perform review of cases to identify referral for case management...

Utilization Review Nurse Are you looking for an attractive career option that offers you an alternative to the high-pressure patient care environment and an opportunity to make a difference? Are you tired of working nights and weekends? Located in Chicago s west suburbs, our medical cost and quality management company serving Illinois Medicaid population is seeking a Utilization Review Nurse. The successful candidate will have an active, unrestricted Illinois registered nurse license, minimum of three

Bottom Line Systems, Inc. Named one of the Top 30 Best Places to Work in Kentucky 2009! Utilization Review Nurse Looking for a career with a stable, award winning company experiencing tremendous growth and opportunity? Look no further! Bottom Line Systems, Inc., recently named one of the Top 30 Best Places to Work in Kentucky for 2009, is a health care consulting company, specializing in identifying and collecting managed care underpayments and denials for our customers for the past 12-years! Our

Applied Underwriters is searching for a Utilization Review Nurse to perform of day-to-day Utilization Management activities related to workers compensation, including, but not limited to, review of clinical information to determine medical necessity at all levels of care utilizing criteria- or evidence-based guidelines, interacting with physicians, claimants and peer reviewers as part of the Utilization Management process. Applied Underwriters is setting the standard in the field of workers compensation.

Utilization Review Nurses Our client, a Medicare Advantage Health Maintenance Organization (HMO), is committed to offering comprehensive, affordable, and valuable healthcare to Medicare beneficiaries. They are seeking two Utilization Review nurses for a 3 month assignment in their downtown Manhattan offices.. Job Requirements: - UM/UR experience necessary - Milliman guidelines - Managed care and Medicare experience preferred - RN license, New York State

Three to five years experience performing utilization review or case management...General understanding of claims process case management bill review PPOs...

Review medical records evaluate level of care interact with MD s Case Managers discharge planning...Must be active RN Position Description Collect case specific member information review and certify the...Review each case and determine the most appropriate services the...

Document case review findings actions and outcomes in accordance with policy...

3 30p 1 30p 10 00p Collect case specific member information review and certify the...Review each case and determine the most appropriate services the...Review Early initiation of discharge coordination Analyze case specific patient information...

This position is open as of 11/16/2009. Medical Record Review Nurse - Utilization Review Registered Nurse - Medical Claims Auditing Nurse Medical Record Review Nurse - Utilization Review RN If you are a Registered Nurse with at least one year of experience in utilization review or a managed setting, please read on! What you need for this position: Licensure as a Registered Nurse At least one year of experience in utilization review or a managed setting Risk pool handling experience is required What

Boston-based Liberty Mutual Group is a diversified global insurer and sixth largest property and casualty insurer in the U.S. based on 2007 direct written premium. The Company also ranks 86th on the Fortune 500 list of largest corporations in the U.S. based on 2008 revenue. As of December 31, 2008, Liberty Mutual Group had $104.3 billion in consolidated assets, $94.2 billion in consolidated liabilities and $28.9 billion in annual consolidated revenue. Liberty Mutual Group offers a wide range of insurance products

criteria to Physician Reviewer Refer cases to case management Research clinical questions from employers members...

in California for Utilization Management Quality Management Case Management Workers Comp Audit Discharge Planning other...

Degree Skills Health Care RN Social Work Case Management Category Healthcare Rehabilitation FTE 01 Position...Air Job FairAmarilloJobSpot comAmerica s Job BankAmerican Case Management AssociationAmerican Health Information Management AssociationAmerican Nurse...

Utilization Review Coordinator Department Case Management Schedule Full Time Shift Day shift...

The temporary Home Care Utilization Review Nurse will conduct clinical reviews of pediatric and young adult members for all inpatient stays, homecare, outpatient rehabilitative therapy, durable medical equipment and long term care services based on standardized criteria. Responsible for both the management of resources and the achievement of desired outcomes for members with ongoing communication to the Director of Care Management and Utilization Management, the Medical Director and staff for the development

Surveillance and Utilization Review (SUR) Audit Supervisor Duties and Responsibilities: - Assist in annual plan development; - Manages SUR audit staff, including regular evaluations; - Supervises Lead SUR Prepayment Reviewer; - Sustains knowledge of medical and program policy changes that affect SUR audit responsibilities; - Coordinates training for audit staff as necessary; - Determine random samples using the Office of Audit Service of the Office of Inspector General s RAT

experience in medical office social service or case management experience a plus Skills Superior customer...

Ready to make a change from traditional nursing to a job that does not require weekends and holidays and... allows you to use your brain not your muscle! The Monroe Plan for Medical Care(MPMC) is actively seeking a Licensed Practical Nurse for a Utilization Review Nurse opening. Under the supervision of a Registered Nurse, the UM LPN performs initial clinical review for medical appropriateness of health care services. The Utilization Review Nurse seeks to enhance our member's access to care and services while

back up coverage for After Hours Clinical Case Managers as assigned Other duties as assigned...clinical team for discharge planning Performs telephonic case review for pre admission and continuing care...

Case Manager Certification highly desirable...The Care Manager is certified or eligible to become certified in Case Management Outcomes Management or Healthcare Quality...

Case Manager Certification highly desirable...The Care Manager is certified or eligible to become certified in Case Management Outcomes Management or Healthcare Quality...

Maintains organized records of the Utilization Review Department. Completes RTC/ Acute prior authorizations and concurrent reviews in a timely manner. Monitors and reports on any deficient areas noted within the chart. All documentation is clear, and consistent. Maintains education regarding various 3rd party insurance companies. Demonstrates conduct in keeping with Hospital ethical standards. Has understanding of the program rules and levels system, and how to utilize these to manage patient behavior

care when allowed by state jurisdiction Refers case to a review physician when the treatment...calls made and received in regard to case communication and all demographic and service group...

2 years demonstrated experience in utilization review case management and discharge planning in an Acute Care setting...

2 years demonstrated experience in utilization review case management and discharge planning in an Acute Care setting...

The Utilization Review Coordinator performs admission and concurrent review of patients. Assures optimum quality of patient care in the most cost-effective manner. Works with the Physicians and the Social Services department to ensure quality of documentation of patient care.. Job Requirements: Master s Degree in psychology, counseling, social work or related field. Bachelors degree in Nursing. Three (3) to five (5) years experience in chart analysis and utilization review in the psychiatric and chemical

Review medical records evaluate level of care interact with MD s Case Managers discharge planning...

2 years demonstrated experience in utilization review case management and discharge planning in an Acute Care setting...

Review Department Behavioral Health Services Description Identifies case management needs in collaboration with the patient...

Our Home Health Services department delivers skilled, compassionate care by professional staff, 7 days a week, with a proven shortened recovery time and reduced re-hospitalization rates. What would a Quality Improvement/Utilization Review Manager find working for Presbyterian Intercommunity Hospital? A culture that encourages professionals to support and collaborate with each other and is dedicated to the goal of continuous improvement in the quality of care. Home health is a vital part of our organization

May perform review of cases to identify referral for case management...

Review medical records evaluate level of care interact with MD s Case Managers discharge planning...

2 years in experience in utilization review case management or managed care Previous Precert experience...

2 years in experience in utilization review case management or managed care Previous Precert experience...

The Judge Group is recruiting for a Utilization Review Coordinator for a client in Wilmington, DE. Job Responsibilities: - Responsible for conducting utilization reivew of all assigned admissions - Responsible for justifying continued stay through telephone, email, fax, or on-site review - Confirms eligibility of members - Additional duties as assigned Qualifications: - Must be a licensed RN in Delaware - Minimum of 5 years acute nursing experience - Previous utilization management experience

who has experience reviewing medical documents and case management Responsible for performing medical reviews evaluate...

and psychosocial support Promoting customer service and case satisfaction to achieve established goals and objectives...