Utilization Review Specialist
2 weeks ago
Job Description ECU Health About ECU Health Medical CenterECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.Position Summary The Utilization Review Specialist will ensure regulatory compliance with CMS Conditions of Participation with regard to Utilization Management. Perform Utiliztion Review according to CMS and commercial payor guidelines. Participate in denial / appeal process.Responsibilities Utilizes the nursing process to assess, plan, implement and evaluate the utilization management needs for patients in assigned caseload. Performs utilization management activities using approved screening criteria.Initiates cost savings strategies to achieve decreases in patient resource utilization.Provides follow up with appropriate resource for utilization management issues/non-compliance.Clinical Progression and Utilization Management. Participates in quality improvement (QI) activities.Advances clinical expertise through attendance at in-hours education opportunities, reading journals and attendance at conferences.Collaborates effectively with departmental staff to achieve goals and objectives.Minimum Requirements Associates Degree in Nursing required; BSN preferred. NC RN licensure required.If ADN prepared must have 5 + years experience in an acute care hospital; home health agency; commercial insurance company; case management.If BSN prepared must have 3-5 years experience in an acute care hospital; home health agency; commercial insurance company; case management.A certification in Case Management (i.e. CCM, ACM) can substitute for 1 year of experience; Masters Degree in health related field can substitute for 1 year of experience.Other Information Shift: 8:30-5:00 PM Mon-Fri General Statement It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.
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Utilization Review Specialist
7 days ago
Greenville, United States Vidant Health Full timeJob Description ECU Health About ECU Health Medical Center ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet designation...
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Greenville, South Carolina, United States ECU Health Full timeUtilization Review/Physician Advisor Opportunity in Greenville, NC (Partial Remote) ECU Health Physicians and ECU Health Medical Center, located in Greenville, North Carolina, are seeking a physician to work as a Utilization Review Physician Advisor. The successful applicant will be a part of ECU Health Clinical Documentation Advisor Program and will have...
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Greenville, United States ECU Health Full timeUtilization Review/Physician Advisor Opportunity in Greenville, NC (Partial Remote) ECU Health Physicians and ECU Health Medical Center, located in Greenville, North Carolina, are seeking a physician to work as a Utilization Review Physician Advisor. The successful applicant will be a part of ECU Health Clinical Documentation Advisor Program and will have...
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Greenville, United States ECU Health Full timeECU Health Physicians and ECU Health Medical Center, located in Greenville, North Carolina, are seeking a physician to work as a Utilization Review Physician Advisor. The successful applicant will be a part of ECU Health Clinical Documentation Advisor Program and will have close working relationships with both the utilization review (UR) and appeals staff....
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Remote Director, Medical Review
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Greenville, United States HealthPRO Heritage Full timeOverview The Director, Medical Review will: Lead tracking and coordination of all direct bill therapy appeals, ensuring thorough data compilation and analysis. Lead ALJ hearing preparation and maintain professional communication with facility and corporate personnel. Communicate effectively with public and medical personnel promoting clinical excellence....
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Denials Specialist
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Greenville, United States Vidant Health Full timeJob Description ECU Health About ECU Health ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers...
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Greenville, United States Crossroads Treatment Center Full timeCrossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Position Overview The Accounts Receivable Specialist will be accountable for working accounts receivable follow-up and is responsible for performing third party insurance follow-up in the Central...
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Hybrid RCM AR Specialist
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Greenville, United States Crossroads Treatment Center Full timeCrossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Position Overview The Accounts Receivable Specialist will be accountable for working accounts receivable follow-up and is responsible for performing third party insurance follow-up in the Central...
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Professional Billing Specialist
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Greenville, United States Vidant Health Full timeProgressively responsible for revenue cycle functions related to government, managed care, commercial, third party, grant funds, and other payers for a multispecialty physician organization. Responsibilities 1. Review and make all necessary correctio Billing Specialist, Billing, Specialist, Professional, Claims, Healthcare
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Professional Billing Specialist
2 days ago
Greenville, United States Vidant Health Full timeProgressively responsible for revenue cycle functions related to government, managed care, commercial, third party, grant funds, and other payers for a multispecialty physician organization. Responsibilities 1. Review and make all necessary correctio Billing Specialist, Billing, Specialist, Professional, Claims, Healthcare
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Mechanical Piping and Utilities Engineer
3 weeks ago
Greenville, United States Channel Personnel Services Full timeJob DescriptionJob DescriptionOpportunity for an experienced Piping & Utilities Engineer to prepare and manage design packages for industrial manufacturing clients. This key role requires expertise with industrial process piping systems, to include studies, calculations, stress analysis, equipment specs, and subcontractor bid reviews. QUALIFICATIONS /...
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Remote Director, LTC Medical Review
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Greenville, South Carolina, United States Healthpro Heritage, LLC Full timeOverview: General Description The Director, LTC Medical Review will: Lead tracking and coordination of all direct bill therapy appeals, ensuring thorough data compilation and analysis. Lead ALJ hearing preparation and maintain professional communication with facility and corporate personnel. Communicate effectively with public and medical personnel...
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Remote Director, Medical Review
6 days ago
Greenville, South Carolina, United States Healthpro Heritage, LLC Full timeOverview: The Director, Medical Review will: Lead tracking and coordination of all direct bill therapy appeals, ensuring thorough data compilation and analysis. Lead ALJ hearing preparation and maintain professional communication with facility and corporate personnel. Communicate effectively with public and medical personnel promoting clinical excellence....
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Sr Piping
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Greenville, United States Stealth Recruiting Services Full time120k to 150k Job Description Opportunity for an experienced Piping & Utilities Engineer to prepare and manage design packages for industrial manufacturing clients. This key role requires expertise with industrial process piping systems, to include studies, calculations, stress analysis, equipment specs, and subcontractor bid reviews. Qualifications...
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Senior Mechanical Engineer
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Greenville, United States TekGarden Full timeSenior Mechanical Engineer – Piping & Utility Greenville, SC We are seeking a Senior Mechanical Engineer, experienced in piping, to join well-respected leader in design, construction, & delivery of complex industrial manufacturing & distribution facilities. This role will specialize in Piping & Utility Systems to prepare & manage design packages across...
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Sr Piping
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Greenville, United States Stealth Recruiting Services Full timeJob DescriptionJob Description120k to 150kJob DescriptionOpportunity for an experienced Piping & Utilities Engineer to prepare and manage design packages for industrial manufacturing clients. This key role requires expertise with industrial process piping systems, to include studies, calculations, stress analysis, equipment specs, and subcontractor bid...
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Fleet Service Specialist
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