Utilization Review - Short Hills, NJ

The Utilization Review Operations Lead oversees operational effectiveness, workflow management, and performance of utilization review functions. · Partners with clinical lead, revenue cycle, compliance, and IT teams to optimize systems and processes while maintaining regulatory c ...

The Utilization Review (UR) Clinical Lead oversees the UR process ensuring medical necessity regulatory compliance and appropriate use of healthcare resources. · Provide day-to-day clinical leadership guidance to the Utilization Review team · Serve as a subject matter expert for ...

Provides timely and thorough clinical information to insurance companies and other intermediaries to secure payer authorizations and avoid denials or reduction in level of care. · ...

This position provides timely and thorough clinical information to insurance companies and other intermediaries to secure payer authorizations and avoid denials or reduction in level of care. · ...

Provides timely and thorough clinical information to insurance companies and other intermediaries to secure payer authorizations and avoid denials or reduction in level of care. · ...

The Utilization Review Nurse processes prospective concurrent retrospective UM medical requests while ensuring compliance with SPD time frames clinical policies operational workflows. · Process prospective concurrent retrospective UM medical requests · Maintain monitor review the ...

VillageCare is seeking a self-motivated RN Utilization Review Nurse for Full-Time position in hybrid model from home within New York Tri-State Area. · Reviews planned health care services to ensure medical necessity and effectiveness according to evidence-based criteria. · Freque ...

The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical records for the patient population and Hackensack University Medical Center. · The physician provides direction and support ...

Bronx Psychiatric Center is recruiting for a Utilization Review Coordinator to analyze and evaluate quality, effectiveness, and efficiency of psychiatric and medical services provided to individual diagnosed with mental illness. · ...

We are looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from the comfort of your own home. · Reviews planned, in process, or completed health care services to ensure medical necessity and ...

Utilization Review RN · Clinical Document-Coding Mgmt · Saint Peter's is among the few hospitals in the world to have earned its 7th consecutive Magnet designation and its first Magnet with Distinction designation. The Magnet with Distinction designation is an elite level of this ...

We are seeking an experienced and compassionate Utilization Review Nurse to join our team at Bertrand Chaffee Hospital in Springville New York In this role you will play a critical role in reviewing patient care plans and ensuring that medical services are provided in a cost-effe ...

REPORTS: Director of Utilization Review · DEPARTMENT: Clinical · LOCATION: George Rosenfield Center for Recovery - 13 Hell Gate Circle, Ward's Island, NY 10035 · MAJOR FUNCTIONS: · Under the direction of the Director of Utilization Review, the Specialist will coordinate Medicaid ...

The Utilization Review Nurse will assess member needs and identify solutions to promote high-quality health care services. · ...

· Are you looking to take your career to new heights with a leader in healthcare? SUNY Downstate Health Sciences University is one of the nation's leading metropolitan medical centers. As the only academic medical center in Brooklyn, we serve a large population that is among the ...

Clinical Document-Coding Mgmt · Saint Peter's is among the few hospitals in the world to have earned its 7th consecutive Magnet designation and its first Magnet with Distinction designation. The Magnet with Distinction designation is an elite level of this recognition, awarded to ...

The Department of Case Management at SUNY Downstate Health Sciences University is seeking a full-time TH Utilization Review & Quality Assurance Senior Coordinator / Utilization Review Nurse. · The successful candidate will: · Report directly to the RN Case Management Manager.Revi ...

RN- Utilization Review Nurse · Inpatient · *Hybrid* · Must reside within the New York Tri-State Area - NY, NJ, or CT · COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE · VillageCare is looking for a self-motivated and passionate RN as Utilization Review Nurse ...

Utilization Review RN · Clinical Document-Coding Mgmt · Saint Peter's is among the few hospitals in the world to have earned its 7th consecutive Magnet designation and its first Magnet with Distinction designation. The Magnet with Distinction designation is an elite level of th ...

We are looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from the comfort of your own home as you will be responsible for the assessment of member needs and identification of solutions tha ...