Physician Advisor - Utilization Review & Medical Necessity
NEJM
NEJM is seeking a Physician Advisor to conduct timely, compliant medical necessity reviews and support denials management within the centralized Utilization Review (UR) process for Sentara hospital facilities. The role requires an active Virginia medical license, board-certified status, and on-site presence to collaborate with medical staff and hospital leadership. Responsibilities include peer-to-peer discussions with payers, preparing appeal letters, and education across clinical Revenue #J-18808-Ljbffr NEJM
- Med-Metrix is seeking a Physician Advisor to perform case reviews across all types, ensuring medical necessity and optimal use of hospital resources. You will collaborate... ..., case management, discharge planning and utilization management to improve documentation, coding...Medical
- Physician Advisor UR and CDI-Utilization Management Summary: The Physician Advisor is a key member of the healthcare... ...Improvement and Utilization Review departments and the hospital... ...and under-utilization of resources, medical necessity, levels of care, denial management...Medical
- Job Description Overview: The Physician Advisor conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing... ...letters) in support of the centralized system Utilization Review (UR) process for Sentara hospital...Medical
$230k
...community at a time. Company: Oak Street Health Title: Utilization Management Physician Reviewer Location: Fully Remote Salary: $230k per year Role... ..., the Physician Reviewer is responsible for ensuring medically appropriate care is recommended to the patient and...MedicalHourly payFull timeLocal areaRemote work$248.5k - $373k
...internal medicine or family medicine physician to join our Utilization Management team. Optum is a... ...way clinicians work and live. The Medical Director for Utilization Management... ...processes Participates in case review and medical necessity determination Maintain proficiency...MedicalMinimum wageFull timeWork experience placementWork at officeLocal areaRemote workWork from home$360.62k - $414.59k
...Description Physician Affiliate Group of New York (PAGNY) is adding a Physician Advisor to the group at NYC Health + Hospitals... ...Serve as a key member of the Utilization Management team, leading... ...utilization of resources, medical necessity, level of care, care progression...MedicalDaily paidFull timeImmediate startFlexible hours$100 per hour
## Physician, Concurrent Inpatient Review (PT Evenings/Weekends) (Remote) (Hospital Advocacy... ....**JOB SUMMARY:**As a Medical Director, Concurrent Review... ...across the country while utilizing your medical knowledge... ...experience as an expert advisor to CorroHealth’s client hospitals...MedicalRemote jobHourly payWork at officeImmediate startWork from homeMonday to FridayWeekend workAfternoon shift- MarinHealth is seeking a Utilization Review Nurse II to perform admission, concurrent and retrospective reviews for designated health plans... ...for continued care, and collaborate with a multidisciplinary team to ensure medical necessity #J-18808-Ljbffr Marin General HospitalMedical
- ...Oak Street Health seeks a full-time Utilization Management Physician Reviewer to determine coverage for inpatient and outpatient services using UM criteria... ...emphasizes coordinating with care teams to ensure medically appropriate care and adherence to CMS/MCG guidelines....Full timeRemote work
- ...BlueCross BlueShield South Carolina subsidiary, seeks a Medical Reviewer II (RN) to perform medical claim reviews and determine medical necessity using established guidelines. The role documents decisions and supports utilization review across multiple services. The position is...MedicalRemote jobFull time
$77.02k - $117.58k
...Times’ Top Workplaces. Summary The Utilization Review Nurse is responsible for performing... ...retrospective utilization reviews to determine medical necessity, appropriate level of care, and... ...with Case Management, Physician Advisors, providers, and payers. The Utilization...MedicalFull timeWork at office- ...be located in Northeast New Jersey Company Overview Blackstone Medical Services is dedicated to providing exceptional at-home sleep... ...will have a history in Sales building strong relationships with physicians and their staff. The majority of your time will be spent...MedicalWork at office
- ...Compass Health Center is seeking a Remote Utilization Review Specialist to obtain insurance authorization for patients receiving Behavioral... ...financial barriers to treatment. The role requires knowledge of medical terminology, psychiatric criteria, and strong written/verbal...MedicalRemote work
$25 - $31 per hour
...on your desk is a moment where your review decides what happens next for a... ...and pace are what keep the entire utilization review process trustworthy. Schedule... ...skilled nursing, and rehab stays, for medical appropriateness and necessity. Drive post-service reviews: Evaluate...MedicalHourly payMonday to Friday- ...exceptional service. Senior Portfolio Advisor The Senior Portfolio Advisor... ...and continuous growth in the utilization and appropriate execution of... ..., feedback from the REV peer review process, and sound risk... .... If, because of a medical condition or disability, you...MedicalWork experience placementH1bLocal areaWorldwideFlexible hours
- Personify Health is hiring an LVN-licensed reviewer to assess outpatient, inpatient, and mental health pre-certifications for medical appropriateness and necessity. You will also drive post-service reviews to verify medical necessity, escalate complex cases, and coordinate...Medical
- INTEGRIS Baptist Medical Center in Oklahoma City, OK, is seeking a day shift/variable, part time RN Case Manager - Utilization Review. The role requires comprehensive patient assessments, discharge planning, and coordinated care across departments to ensure appropriate...MedicalPart timeDay shift
- ...Washington DC area, is seeking an experienced Case Reviewer to join our healthcare consulting practice.... ...to Columbia, MD. As a Case Reviewer in the Utilization Management department, you will perform utilization review and medical management of prior authorizations, ensuring...MedicalRemote job
- INTEGRIS Baptist Medical Center in Oklahoma City, OK is seeking a day shift/variable, full-time RN Case Manager - Utilization Review. You will assess patients, coordinate transfers, and develop discharge plans to optimize resources and patient outcomes. Qualifications include...MedicalFull timeDay shift
$23.76 - $51.49 per hour
...Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established... ...promote the Molina care model. Adheres to utilization management (UM) policies and procedures. Required...MedicalHourly payWork experience placementWork at office$110k
...with the most efficient utilization of resources. Carries... ...visitors, families, physicians, staff, etc.)... ...documentation for justification. Reviews the patient’s plan of... ...refer to appropriate advisor. 4. Monitors the... ...level of care and medical necessity in the Care Management...MedicalDaily paidFull timePart timeFlexible hoursShift work- Personify Health is seeking a qualified RN to perform medical-necessity reviews, ensuring appropriate care levels and strict adherence to policy language and regulatory requirements. You will evaluate documentation, escalate non-certifications, and coordinate with Medical...Medical
- ...Government Lands Right of Way, Advisor at Southern California Edison... ...'ll receive assignments and review completeness of package... ...to secure California Public Utilities Commission (CPUC) and government... ...proprietary information, confidential medical records, and other types of...MedicalAgency workPermanent employmentTemporary workLocal areaRemote work
$100k - $125k
...Job Summary The Total Rewards Advisor serves as the organization's... ...execution. Evaluate benefit utilization trends and provide recommendations... ...for leadership team review. Provide cost modeling and financial... ...tools. Health Care Plan (Medical, Dental & Vision) Retirement...MedicalTemporary workLocal area$119.6k - $199.3k
SUMMARY The Senior Advisor, Drug Trends and Pipeline Strategy will... ...Conduct external and internal reviews of the healthcare landscape (... ...in the marketplace Utilize internal data and modeling to... ...annual bonus plan. Benefits Medical Vision Dental Well-being and...MedicalContract workLocal areaWork from home- LaSalle Medical Associates IPA in California is seeking a Licensed Vocational Nurse to support denial review and compliance activities. The role focuses on accurate denial language... ...California LVN license. Training in utilization management or healthcare compliance is...MedicalWork at office
- ...The Maintenance Team Advisor directly oversees the... ...events. Use of EAM: Utilize enterprise asset management... ...requirements are met. Reviews incidents during which... .... Get access to medical, prescription drug, dental... ...can meet the travel necessities of the position are required...MedicalExtra incomeFor contractorsRelocationRelocation packageShift workNight shift
$105k - $120k
## Senior Advisor Programs ManagerApplyremote type: Hybridlocations... ...and quarterly reporting* Review, analyze, interpret, and maintain... ...of complex programs and utilizing best practices in management... ...Off* 401K - 6% Employer Match* Medical, Dental, Vision - HDHP or PPO...MedicalFull timeFlexible hours$54.62k - $100.49k
...Initiative’s multimedia storytelling capacities, utilizing both archival materials and ongoing... ...work mode designations are regularly reviewed in order to meet the evolving needs of... ...competitive benefit package that includes medical, dental, vision, disability and life...MedicalHourly pay$93 per hour
...an independent contractor 1099 position.The Physician shall perform medical histories, physical examinations, as well as review required medical tests and documents pertaining... ...providersAbility to effectively plan and utilize time while administering judgement and demonstrating...MedicalFor contractorsReliefLocal area
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