FEATURED JOBS
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…and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and
…Excellence in Perinatal Care Hip- and Knee- Replacement. **Responsibilities** **_Utilization Review RN - remote position_** **Position Summary:** The incumbent is
…of clinical decision making and support needed to perform utilization management, medical necessity determinations and benefit determinations using applicable
…Conducts reviews of cases lost with feedback to respective departments + Conduct concurrent review with utilization review department for post op surgical
…patients. + Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). +
Clinical Payment Resolution Specialist-I (Hospital Denials & Appeals) - PFS (Remote)
Trinity Health
…rejection, denial and appeal activities with Ministry Organization (MO) based Utilization Review /Case Management departments; + Reviews and understands
…Manager (CM) performs a wide variety of tasks and functions. These include utilization review , discharge planning, care coordination and variance management to
…and patient care as indicated and required; + May participate in quality assurance/ utilization review or other non-direct patient care nursing assignments; and +
…managed care (Medicare and/or Medicaid) Experience with managed care (Medicare and Medicaid) utilization review preferred MD or DO; Board certification in an
…to their practice. 13. Performs other duties as assigned, including utilization review as necessary. **Qualifications** **Education and Experience** Required