Find clinical, allied health, care team, and healthcare operations openings using one smart search field across cities, regions, and employers.
University of Maryland Medical System
Overview
Performs microscopic screening and testing of patient specimens in the Cytology Laboratory to assist in disease diagnosis. Provides adequacy assessments and technical support during fine needle aspirate procedures.
Quick view →
Compensation
$41 - $62 / HOUR
Posted
23 days ago
WVU Medicine
This role coordinates quality improvement, assurance, and patient safety activities to maintain and enhance patient care services. Responsibilities include performing quality review studies, analyzing and reporting data, leading performance initiatives, and investigating patient complaints.
Salary not listed
1 month ago
SUN BEHAVIORAL HEALTH GROUP
The Utilization Management Specialist coordinates patient care from pre-hospitalization through discharge, including managing insurance authorizations and appeals. They also maintain accurate clinical documentation and facilitate communication between medical staff and third-party payors.
2 months ago
SUN Behavioral Delaware
The Utilization Management Specialist coordinates case management strategies and assists with patient care from pre-hospitalization through discharge. They are responsible for obtaining insurance authorizations, processing appeals, and maintaining accurate documentation for patient admissions and reviews.
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
Kaiser Permanente
The Patient Care Coordinator RN is responsible for optimizing the quality and efficiency of care for hospitalized members through daily utilization and quality reviews, discharge planning, and care coordination. This involves collaborating with multidisciplinary teams to develop safe discharge plans and ensuring compliance with all relevant regulations to achieve desired utilization and quality outcomes.
St. Luke's University Health Network
The specialist analyzes medical records, claims data, and coding to appeal insurance provider MS-DRG and coding changes, ensuring the most accurate ICD-10-CM/PCS codes support rendered services. Duties include conducting retrospective reviews, developing appeal arguments, and identifying documentation issues for staff education.
SSM Health
The Case Manager coordinates systems and services using a trans-disciplinary team approach to deliver quality, cost-efficient care across the healthcare continuum. This involves collaborating with patients, families, and the care team to facilitate appropriate movement through the care continuum.
West River Health Services
The Utilization Review Specialist monitors resource utilization and quality of care for patients, ensuring compliance with established guidelines. They perform preadmission reviews, coordinate with discharge planners, and manage insurance communications.
This role optimizes the quality and efficiency of care for hospitalized members through daily utilization and quality reviews, discharge planning, and care coordination with multidisciplinary teams. Responsibilities include performing utilization reviews, assessing discharge needs, coordinating post-hospital care, and ensuring compliance with all relevant regulations.
3 months ago
Adventist Health
This role coordinates and provides utilization, disease and case management, and health coaching services to health plan members, applying advanced knowledge to meet goals and potentially serving as a working supervisor. Key functions include acting as a liaison to various parties, leading retrospective reviews, confirming orders, and enhancing communication related to care coordination and utilization management.
$24 - $31 / HOUR
Davies
The role involves independently managing medical claims for injured workers in a Workers' Compensation environment, focusing on coordinating care to ensure quality medical outcomes and timely, cost-effective return-to-work.
$75,000 - $83,000 / YEAR
AmTrust Financial Services, Inc.
The primary purpose is to provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider, and employer. Responsibilities include utilization review, pharmacy oversight, and care coordination while partnering with adjusters on a holistic approach for each claim.
$66,900 - $91,000 / YEAR
The primary purpose is to provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work by engaging the injured employee, provider, and employer. Responsibilities include utilization review, pharmacy oversight, and coordinating treatment while maximizing quality and cost-effectiveness of care.
MOUNTAIN VIEW HOSPITAL LLC
The Utilization Review Case Manager is responsible for ensuring prompt and accurate handling of medical necessity reviews and collaborating with healthcare professionals to improve patient care. This includes performing reviews, consulting with medical directors, and managing delays in care.
5 months ago
