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Saint Luke's Health SystemNew
Overview
The specialist reviews medical records to ensure accurate representation of illness severity, complications, and comorbidities. They are responsible for educating clinical providers on compliant documentation and collaborating with the coding team.
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Compensation
Salary not listed
Posted
New
Lifepoint Health
Facilitates clinical reviews for patient admissions and continued stays to determine the legitimacy of treatment and length of stay. Interfaces with managed care organizations and payers to secure insurance coverage and advocate for necessary patient treatment.
$33 - $45 / HOUR
4 days ago
Gainwell Technologies LLC
The Utilization Review Nurse will conduct reviews for medical necessity and appropriateness of services, ensuring compliance with clinical criteria and policies. This includes engaging with providers, documenting findings, and assisting in training new nurses.
$65,000 - $78,000 / YEAR
6 days ago
Facilitates clinical reviews for patient admissions and continued stays to determine the appropriateness of treatment and length of stay. Coordinates with managed care organizations and interdisciplinary teams to ensure insurance authorization and access to necessary care.
1 month ago
The specialist manages inpatient and outpatient authorizations, pre-certifications, and appeals to secure necessary patient coverage. They collaborate with interdisciplinary teams and physicians to ensure documentation requirements are met and denials are accurately reported.
Cedars-Sinai
The Clinical Prior Authorization Pharmacist Specialist collaborates with providers and technicians to ensure safe, effective, and reasonable use of high-cost drug therapies. Responsibilities include managing prior authorizations, analyzing claim data, supporting the appeal process, and supervising pharmacy technicians.
$77 - $124 / HOUR
The Utilization Review Specialist manages inpatient and outpatient authorizations, including pre-certifications and re-certifications. They also coordinate with interdisciplinary teams and physicians to ensure documentation compliance and facilitate peer-to-peer reviews.
Torrance Memorial Medical Center
The RN Case Manager establishes and manages discharge and transition plans for inpatient members in collaboration with the hospitalist team. They assess patient needs, monitor care appropriateness, and facilitate transitions to lower levels of care to prevent readmissions.
2 months ago
Beth Israel Lahey Health
The Case Manager will utilize established clinical criteria to identify appropriate care settings and collaborate with clinical staff, patients, and families to develop post-hospital care plans. Responsibilities also include providing clinical information to insurers and serving as a liaison for smooth transitions of care.
$79,269 - $204,318 / YEAR
Curant Health
This role primarily involves performing duties related to specialty medication prior authorization requests according to established protocols and clinical criteria. Key tasks include defining and coordinating prior authorization reports, interfacing with providers regarding benefits, and serving as a clinical resource for internal and external stakeholders.
The Utilization Review Specialist facilitates clinical reviews for all patient admissions and continued stays, analyzing records to determine the legitimacy of treatment and length of stay while interfacing with payers. This role involves advocating for patients with substance abuse or psychiatric disorders to secure necessary treatment coverage and assisting the treatment team with insurance requirements for continued stay and discharge planning.
Community Health Systems Professional Services Corporation
The Transfer Coordinator RN is responsible for coordinating all aspects of patient transfers, admissions, and consultations into and out of CHS facilities, performing initial admission screening against clinical criteria. This role involves collaborating with capacity coordinators and external providers to ensure efficient patient flow and address throughput barriers.
3 months ago
UT Southwestern Medical Center
The technologist is responsible for maintaining a clean and supplied work area, checking equipment functionality, and performing quality control on assigned equipment. Duties also include verifying patient identification, communicating professionally with patients, assessing clinical criteria, and assisting with patient preparation and positioning for exams.
The technologist is responsible for performing mammography procedures, ensuring proper patient preparation, communication, and positioning while maintaining a clean and supplied work area. Duties also include performing quality control on equipment, attending meetings, and adhering to departmental policies regarding time and attendance.
The technologist is responsible for maintaining a clean and supplied work area, checking equipment functionality, and performing quality control on assigned equipment. Duties also include verifying patient identification, communicating professionally with patients, assessing clinical criteria, and assisting with patient positioning for exams.
The technologist is responsible for maintaining a clean and supplied work area, checking equipment functionality, and ensuring timely response to procedural inquiries. Duties also involve performing quality control on assigned equipment and adhering to departmental guidelines.
