Register
Recruit Create CV

Utilization Review Resource Specialist Jobs

Utilization Review Specialist Jobs
By Southwest Florida Home Care, Inc. At , Remote
Yes, Home Health Care Experience is required and OASIS certification is preferred. Additional+2 years experience is preferred
Do you need Home Health Care Experience?
Growing Florida Home Care Organization
Team and family focused organization
Florida Nursing License LPN or RN compact accepted
Ability to review high volume documents with accuracy and efficiency
Utilization Review Specialist Jobs
By St. Charles Health System At , Bend, 97701, Or $24.32 - $33.44 an hour
Required: Associate's degree or higher in Health Information Management
Intermediate to advanced proficiency in Microsoft applications (Word, Excel and Access), database management, and document preparation
REPORTS TO POSITION: Manager, Utilization Review
Required: Minimum 2 years’ experience in similar hospital related position with utilization experience preferred
Strong team working and collaborative skills
Strong analytical, problem solving and decision making skills
Utilization Review Specialist Sr
By BayCare At , Riverview, Fl
Preferred experience includes Critical Care or Emergency Nursing RN.
Written and verbal communication skills
Knowledge of regulatory standards appropriate to position
Computer skills appropriate to position
Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials.
401k match and additional yearly contribution
Rn Specialist - Utilization Mgmt: Corp - Utilization Review
By Memorial Healthcare System At Miramar, FL, United States
Assists departmental staff with issues related to coding, medical records/documentation, precertifications, reimbursement and claim denials/appeals.
MANAGING WORKLOADS: Manages completion of work assignments based on priority and due dates.
ORGANIZATION SKILLS: Organizes work to achieve maximum efficiency.
Prepares statistical analysis and utilization review reports as necessary.
Reviews admissions and service requests for prospective, concurrent, and retrospective medical necessity and/or compliance with reimbursement policy criteria.
Collaborates with onsite Clinical Effectiveness team regarding patient's discharge readiness.
Utilization Review Specialist Jobs
By Medical Center Hospital At , Odessa, 79761, Tx

Holds a current Texas license as a Registered Nurse.

Utilization Review Clinical Specialist
By CHS Corporate At , Franklin, Tn
Computer Skills Required: Data entry skills; Demonstrable skills with Google Docs, Google Sheets, and email applications.
Location FRANKLIN, TN (CHS Corporate)Full Time
Location FRANKLIN, TN (CHS Corporate)
Utilization Review Specialist Jobs
By Fresno County At , , Ca $88,088 - $107,068 a year
Please click here to view Knowledge, Skills, and Abilities.
Applicants must meet the minimum qualifications and filing requirements for this position by the filing deadline.
TO PREVENT THE DISQUALIFICATION OF YOUR APPLICATION, PLEASE NOTE:
Resumes and attachments are not accepted in lieu of a completed application.
Fresno County Employment Application (must be current, complete, and accurate; amendments will not be allowed after the filing deadline).
Fresno County Department of Behavioral Health
Utilization Review Specialist - Supplemental/As Needed
By Deaconess Health System At , Evansville, 47708, In
Prior experience in case management preferred.
Facilitates communication and updates physicians on third-party payer requirements and phone reviews.
Collaborates with manager to research and resolve barriers in the reimbursement process.
Experience in psychiatric setting is preferred.
Onsite children’s care centers (Infant through Pre-K) at various locations
Free access to fitness centers, where health coaches are available to help with workout plans at various locations
Rn Utilization Review Specialist
By Keck Medical Center of USC At , Los Angeles, 90015, Ca $47.31 - $88.00 an hour

The RN Utilization Management Specialist coordinates communication with admitting financial counselors, case management team, providers, patient financial services, and payers to ensure all services ...

Virtual Utilization Review Specialist - Weekend - Full Time
By Ensemble Health Partners At , Remote
Maintains clinical competency and current knowledge of regulatory and payer requirements to perform job responsibilities (i.e., medical necessity criteria, MS-DRGs, POA).
Other Knowledge, Skills, and Abilities Required:
Communicates all medical necessity review outcomes to in-house care management staff and relevant parties as needed.
Demonstrates active collaboration with other members of the health care team to achieve the outcomes management goals including CMS indicators.
Documentation will reflect all work and communication related to the FCC, payor, physician, physician advisor and in-house care management.
Directs physician and patient communication regarding non-coverage of benefits.
Utilization Review Specialist - Behavioral Health
By Cornerstone Behavioral Health Hospital - El Dorado At , Tucson, 85712, Az
Completes pre and re-certifications for inpatient and outpatient services. Reports appropriate denial, and authorization information to designated resource.
Participates in treatment teams to ensure staff have knowledge of coverage and collects information for communication with agencies.
Works with DON to ensure documentation requirements are met.
Interfaces with managed care organizations, external reviews, and other payers.
CPR Certification and Crisis Prevention Training (CPI) preferred.
Actively communicates with interdisciplinary team to acquire pertinent information and give updates on authorizations.
Specialist , Utilization Review Jobs
By Oaklawn Hospital At , Marshall, Mi
Prepares any reports assigned or requested by the Manager of Case Management or his/her supervisor
Understands and communicates insurance information to team members, including benefits and levels of care
Conducts concurrent or extended stay reviews on appropriate day and/or specified time
Prepares and submits appeals to payors, effectively coordinating collection of all pertinent data to support the hospital and patient’s position
Maintains and updates reviews in the electronic medical record (EMR) and maintains other appropriate records as needed
Communicates pertinent payor issues to physician and other caregivers
Utilization Review Specialist Jobs
By Lexington Medical Center At , West Columbia, 29169, Sc
Communicates with case management triad regarding reimbursement issues.
We are committed to offering quality, cost-effective benefits choices for our employees and their families:
Manages inpatient Medicare discharge expedited appeals process through the QIO.
Indentifies abnormal patterns of utilization and refers to Manager/Director.
Day ONE medical, dental and life insurance benefits
Exhibits commitment and pride through personal example by positively speaking about LMC, the department, employees and guests.
Utilization Review Specialist Jobs
By Emerald Coast Behavioral Hospital At , Fort Walton Beach, 32547, Fl
2 years acute care experience in a behavioral health setting preferred.
Enter authorization and days approved data into financial and clinical information systems to facilitate hospital billing.
Ensure all peer reviews are completed according to insurance specifications.
Conducts concurrent reviews, prepares and presents reports and communicates pertinent information to leadership team when needed.
Challenging and rewarding work environment
Competitive Compensation & Generous Paid Time Off
Utilization Review Specialist Jobs
By Memorial Hermann Health System At , Houston, 77024, Tx
Experience / Knowledge / Skills
Refers cases and issues to Care Management Medical Director in compliance with Department procedures and follows up as indicated.
Effective oral and written communication skills.
Utilizes conflict resolution skills as necessary to ensure timely resolution of issues.
Uses appropriate criteria sets for admission reviews, continuing stay reviews, outlier reviews and clinical appropriateness recommendation.
Takes appropriate follow-up action when established criteria for utilization of services are not met.