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Unity HealthNew
Overview
The role focuses on coordinating utilization management and denial prevention to ensure patients receive the right care at the right cost and setting. Responsibilities include reviewing clinical practices and maintaining a quality control system to optimize hospital facility usage.
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Compensation
Salary not listed
Posted
New
Stony Brook University
The role involves completing utilization reviews for inpatient and observation cases, ensuring patients are in the correct level of care, and managing authorization processes for inpatient stays. Duties also include developing safe discharge plans, documenting avoidable delays, and actively participating with physicians and payers to prevent denials.
$88,000 - $125,466 / YEAR
2 months ago
Riverview Health
The Clinical Case Manager is responsible for analyzing patient records, managing admission and concurrent reviews to prevent payer denials, and coordinating service approvals with payors within required timeframes. This role involves comparing medical records to care guidelines, communicating with the treatment team regarding length of stay and discharge readiness, and supporting utilization review processes including appeals and peer reviews.
3 months ago
Tenet Healthcare Corporation
The role is responsible for facilitating effective resource coordination to ensure patients achieve optimal health and appropriate utilization of resources, balancing this with patient rights. This position manages the medical necessity process, ensuring care is provided at the appropriate level based on medical necessity, which may involve negotiation with payers.
$87,360 - $135,200 / YEAR
