Clinical Utilization Management Specialist
2 months ago
We are seeking a highly skilled Clinical Utilization Management Specialist to join our team at Universal Health Services. As a key member of our multidisciplinary treatment team, you will play a critical role in ensuring the optimal utilization of healthcare resources while promoting positive patient outcomes.
Key Responsibilities- Timely Clinical Reviews: Perform daily clinical reviews with all payer types to secure authorization for continued treatment based on payer criteria.
- Level of Care Requirements: Educate and guide the treatment team on level of care requirements and payer expectations for patient acuity and appropriate utilization.
- Quality and Timely Appeals: Complete quality and timely appeal/denial letters, and participate in post-claim recovery review and ongoing audit activity to ensure compliance with CMS and other regulators.
- Education: Bachelor's degree from an accredited college or university in nursing, or Master's degree in social work, mental health, or a related field.
- Experience: Minimum of one year of experience with communication with external review organizations or comparable entities, or four years of direct clinical experience in a psychiatric or mental health setting.
- Licensure: RN, LCSW, MFT, MSW degree, or LPT.
Universal Health Services is one of the nation's largest and most respected providers of hospital and healthcare services. We are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates.
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Clinical Utilization Management Specialist
3 weeks ago
Sacramento, California, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our healthcare team, you will play a critical role in ensuring that our members receive the most appropriate care at the right time and in the right setting.Key ResponsibilitiesUtilize clinical expertise to coordinate, document, and...
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Clinical Utilization Management Specialist
2 weeks ago
Sacramento, California, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Nurse Consultant to join our team in the Utilization Management department. As a key member of our team, you will play a critical role in ensuring that our members receive the most appropriate care at the right time and in the right location.Key Responsibilities Utilize clinical expertise to coordinate, document,...
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Clinical Utilization Management Specialist
3 weeks ago
Sacramento, California, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our healthcare team, you will play a critical role in ensuring that our members receive the most appropriate care at the right time and in the right setting.Key ResponsibilitiesUtilize clinical expertise to coordinate and document all...
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Clinical Utilization Manager
3 weeks ago
Sacramento, California, United States Universal Health Services Full timeJob Title: Clinical Utilization ManagerAt Universal Health Services, we are seeking a highly skilled Clinical Utilization Manager to join our team. As a key member of our multidisciplinary treatment team, you will play a critical role in promoting positive outcomes and optimal reimbursement through coordination of patient care, daily clinical reviews,...
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Clinical Utilization Manager
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Sacramento, California, United States Universal Health Services Full timeJob Title: Clinical Utilization ManagerHeritage Oaks Hospital, part of the Universal Health Services (UHS) family, is seeking a skilled Clinical Utilization Manager to join our team. As a key member of our multidisciplinary treatment team, you will play a vital role in ensuring optimal patient care and reimbursement.Responsibilities:Conduct daily clinical...
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Clinical Utilization Specialist
1 month ago
Sacramento, California, United States Universal Health Services Full timeJob Title: Utilization Management CoordinatorAt Heritage Oaks Hospital, we are seeking a highly skilled Utilization Management Coordinator to join our team. As a key member of our multidisciplinary treatment team, you will play a critical role in ensuring that our patients receive the highest level of care while promoting positive outcomes and optimal...
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Clinical Utilization Management Consultant
2 weeks ago
Sacramento, California, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Clinical Utilization Management Consultant to join our team. As a Utilization Management Nurse Consultant, you will play a critical role in coordinating, documenting, and communicating all aspects of the utilization/benefit management program.Key Responsibilities- Utilize clinical experience and skills to assess,...
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Utilization Management Specialist
4 weeks ago
Sacramento, California, United States Universal Health Services Full timeJob SummaryWe are seeking a highly skilled Utilization Management Coordinator to join our team at Sierra Vista Hospital. As a key member of our Utilization Management Department, you will play a critical role in ensuring the effective management of patient resources and maximizing the quality of care.ResponsibilitiesManage and review patient utilization of...
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Clinical Resources Nurse
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Sacramento, California, United States Western Health Advantage Full timeJob DescriptionWestern Health Advantage is seeking a skilled Clinical Resources Nurse to join our team. As a key member of our Utilization Management department, you will play a critical role in ensuring that our members receive the highest quality care while also meeting the needs of our health plan.Key Responsibilities:Perform research and evaluation of...
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Sacramento, California, United States Central California Alliance for Health (Remote) Full timeJob Title: Utilization Management Data and Coding SpecialistWe are seeking a highly skilled Utilization Management Data and Coding Specialist to join our team at Central California Alliance for Health (Remote). As a key member of our Utilization Management Department, you will play a critical role in ensuring the accuracy and integrity of our medical coding...
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Utilization Management Coordinator
3 weeks ago
Sacramento, California, United States Universal Health Services Full timeJob Title: Utilization Management CoordinatorSierra Vista Hospital is seeking a dedicated and experienced Utilization Management Coordinator to join our team. As a key member of our Utilization Management Department, you will play a vital role in ensuring the effective management of patient resources and maximizing the quality of care.Responsibilities:Manage...
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Utilization Management Coordinator
3 weeks ago
Sacramento, California, United States Sierra Vista Hospital Full timeJob SummarySierra Vista Hospital is seeking a skilled Utilization Management Coordinator to join our team. As a key member of our Utilization Management Department, you will play a vital role in ensuring the efficient use of resources and maximizing patient care.ResponsibilitiesManage and review patient records to ensure clinical appropriateness and maximize...
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Clinical Specialist
1 month ago
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Clinical Specialist
4 weeks ago
Sacramento, California, United States accordance search group Full timeJob OverviewWe are seeking a highly skilled Clinical Specialist to join our team at Accordance Search Group. As a Clinical Specialist, you will play a critical role in providing clinical case coverage and training to the surgical team on the safe and effective use of our medical devices.Key ResponsibilitiesProvide clinical case coverage as assigned, ensuring...
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Clinical Specialist
1 month ago
Sacramento, California, United States Accordance Search Group Full timeJob Summary:The Clinical Specialist will be responsible for providing clinical case coverage and training to the surgical team on the safe and effective use of medical devices. This role requires a strong understanding of minimally invasive spine procedures and the ability to develop technical acumen to serve as an educational and clinical resource.Key...
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Clinical Diabetes Specialist
2 weeks ago
Sacramento, California, United States Sequel Medical Technology Full timeJob DescriptionSequel Medical Technology is seeking a highly skilled Clinical Diabetes Specialist to join our team. As a Clinical Diabetes Specialist, you will partner with a Territory Business Leader to successfully launch new innovative insulin pumps and future Sequel products. Your primary responsibility will be to deliver unparalleled clinical education...
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Care Management Specialist
1 week ago
Sacramento, California, United States Benefit & Risk Management Services, Inc. Full timeCare Management Specialist**Job Summary:**We are seeking a highly organized and detail-oriented Care Management Specialist to join our team. The successful candidate will provide administrative and clerical support to our Care Management Coordinators, ensuring timely and accurate processing of utilization review requests.**Responsibilities:*** Maintain...
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Utilization Management Nurse Consultant
4 weeks ago
Sacramento, California, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our utilization management team, you will play a critical role in ensuring that our members receive the most appropriate care at the right time and in the right setting.Key ResponsibilitiesUtilize clinical expertise to assess, plan,...
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Utilization Management Nurse Consultant
3 weeks ago
Sacramento, California, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our utilization management team, you will play a critical role in ensuring that our members receive the most appropriate care at the right time and in the right setting.Key ResponsibilitiesUtilize clinical expertise to coordinate, document,...
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Utilization Management Nurse Consultant
4 weeks ago
Sacramento, California, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our healthcare team, you will play a vital role in ensuring that our members receive the most appropriate care at the right time and in the right setting.Key ResponsibilitiesUtilize clinical expertise to coordinate and document all aspects...