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Other Executive
highland park, tx
JOB DESCRIPTION: Under the direction of the VP of Case Management & Continuing Care, the Sr. Director of Utilization Review (UR) is responsible for overseeing the development, implementation, and performance management of Utilization Review services performed across the Tenet enterprise. Leads Tenet Hospital case management operations to develop a
Job Source: Other ExecutiveOther Executive
cockrell hill, tx
JOB DESCRIPTION: Under the direction of the VP of Case Management & Continuing Care, the Sr. Director of Utilization Review (UR) is responsible for overseeing the development, implementation, and performance management of Utilization Review services performed across the Tenet enterprise. Leads Tenet Hospital case management operations to develop a
Job Source: Other ExecutiveOther Executive
university park, tx
JOB DESCRIPTION: Under the direction of the VP of Case Management & Continuing Care, the Sr. Director of Utilization Review (UR) is responsible for overseeing the development, implementation, and performance management of Utilization Review services performed across the Tenet enterprise. Leads Tenet Hospital case management operations to develop a
Job Source: Other ExecutiveOther Executive
irving, tx
JOB DESCRIPTION: Under the direction of the VP of Case Management & Continuing Care, the Sr. Director of Utilization Review (UR) is responsible for overseeing the development, implementation, and performance management of Utilization Review services performed across the Tenet enterprise. Leads Tenet Hospital case management operations to develop a
Job Source: Other ExecutiveOther Executive
dallas, tx
JOB DESCRIPTION: Under the direction of the VP of Case Management & Continuing Care, the Sr. Director of Utilization Review (UR) is responsible for overseeing the development, implementation, and performance management of Utilization Review services performed across the Tenet enterprise. Leads Tenet Hospital case management operations to develop a
Job Source: Other ExecutiveImpresiv Health
Irving, TX, United States
Title: RN Utilization Review II Description: The RN Utilization Review II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This RN is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and func
Job Source: Impresiv HealthBaylor Scott & White Health
Dallas
**About Us** At Baylor Scott & White Health, we support the health of people, families, and communities. Baylor Scott and White is Texas's largest not-for-profit healthcare system, encouraging healthy living. Our Core Values are: + We serve faithfully by doing what's right with a joyful heart. + We never settle by constantly striving for better. +
Job Source: Baylor Scott & White HealthTalentBurst
Irving, TX, United States
Position - RN Utilization Review Shift - Monday-Friday 8 hours Hours - 40 hours/week Location - Irving TX 75039 JOB SUMMARY The RN Utilization Review II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This RN is responsible for performing a
Job Source: TalentBurstDuncanville
Job Description Job Description Two years minimum experience in utilization review. Must possess good grammatical and communication skills. Must be skilled in Microsoft Office applications and have a working knowledge of office equipment.
1. Must be able to see and read handwritten or printed notes and hear and/or interpret instructions (with or without corrective devices.)
2. Must be able to continuously sit for approximately 7 hrs. per 8 hr. shift.
3. Must be able to walk within the facility a total of approximately two (2) hrs. per day.
4. Must be emotionally and physically capable of functioning under stressful situations.
5. If recovering, two years of continuous verifiable abstinence.
General Responsibilities :
Oversee the coordination of the facility's insurance certification including precertification and continued stay reviews, as well as insure all insurance denials, appeals and reconsiderations are completed in a timely manner.
Know and abide by the general provisions of 42 CFR Part 2, “Confidentiality of Drug and Alcohol Abuse Patient Records”, and 45 CFR “Health Insurance Portability and Accountability Act.” This position has unrestricted access to patient identifying and patient health information.
Essential Functions :
1. Coordinate and manage the day to day activities of the Utilization Review Staff.
2. Complete daily reports and assign cases to the Utilization Coordinators, as well as, coordinate with other departments as needed to complete the Utilization Review process.
3. Ensure maintenance of "UR Activity Log", which records every review for the facility with financial classification and U.R. information/activity.
4. Fill in as needed, or re-assign activities, in order to make sure all pre-certifications and continued stay reviews are completed in a timely manner.
5. Review and maintain any correspondence pertaining to certification, appeals, denials or reconsiderations.
6. Complete all Quality Improvement indicators for Utilization Management and report those indicators at the quarterly PIC meeting.
7. Educate Counseling staff regarding documentation of patient care; and educate Crisis staff regarding intake assessments.
8. Participate in the hiring, training, and evaluation of staff as necessary.
9 . Ability to work in a constant state of alertness as to perform the job safely.
10. Ability to work in cooperative manner with co-workers, managers, clients and
prospective managers.
11. Regular attendance.
12. Any other duties as assigned by supervisor.
Email Alert for Director of Utilization Review jobs in Duncanville
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