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Utilization Review Specialist Jobs

Utilization Review Coordinator Wfh
By HCA Healthcare At Nashville, TN, United States
Education assistance (tuition, student loan, certification support, dependent scholarships)
Family support through fertility and family building benefits with Progyny and adoption assistance.
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
Manage Midas Send Payor Non-response and no authorization documented worklist rules and document appropriately
Demonstrate knowledge and effective use of multiple applications, systems and resources
Greater than 2 years' work experience in a healthcare setting required
Utilization Review Specialist Jobs
By MTR TREATMENT CORP At United States
Function as a member of the Billing Team to ensure that all daily responsibilities are met.
Aid in verification of benefits when needed.
Excellent verbal and written communication skills.
Prior Utilization Review experience in a Substance abuse environment.
Knowledge of ASAM and medical necessity guidelines as it relates to substance abuse.
The Utilization Review Specialist will perform pre-certification reviews, concurrent reviews and discharge reviews for substance abuse facilities.
Utilization Review Specialist Jobs
By Within Health At Houston, TX, United States
MUST HAVE EXPERIENCE WITH EATING DISORDER CLIENTS*
Complete precertification process and associated documentation.
Manages time effectively, setting priorities, and consistently meeting deadlines.
Excellent verbal and written communication skills.
Maintain efficient methods for ensuring the medical necessity and appropriateness of prescribed level of care.
Oversee the entire UR process for client journey from admission to discharge.
Utilization Review Rn Jobs
By Saint Luke's Health System At Kansas City, MO, United States

The best place to get care. The best place to give care

Utilization Review Coordinator Jobs
By Meadows Behavioral Healthcare At United States
Conduct reviews to ensure that services and documentation conform to the facility protocols, and the requirements of third party payer sources.
Bachelor/Associates Degree in Nursing preferred or related job experience
Registered Nursing licensure/certification in good standing (RN) CPR Certification optional.
Prefer a minimum of two years experience in a psychiatric setting or behavioral health utilization review.
Knowledge of medical terminology, psychiatric interventions and medications and insurance is essential to this position.
Maintain cumulative documentation regarding actions taken during the UR process.
Aba Utilization Review (Ur) Specialist
By Spectrum Billing Solutions At Skokie, IL, United States
Manage authorization denials including referral for peer review.
Assist the treatment team in understanding payer requirements for admission, continued stay and discharge planning.
3-5 years of related ABA, Substance Abuse, and/or Mental Health experience.
Superior written and oral communication skills
Solid understanding of insurance benefits and coverages.
Strong computer skills (Word, Excel, billing software).
Legal Staffing & Utilization Specialist
By Considine Search At New York City Metropolitan Area, United States
Prepare critical staffing analysis materials for regular Partner and management meetings
Actively assess and analyze attorney workloads, experience, interests, feedback, and availability to effectively staff them on matters
Maintain up-to-date knowledge of firm legal products and how they overlap with attorney expertise to ensure nuanced staffing on cases
Effectively communicate case needs and manage attorney expectations regarding their workload
Collaborate with system managers (3E, Handshake) to identify opportunities for efficiencies in LS&U operations
Possess strong analytical skills with exceptional attention to details and accuracy
Utilization Review Specialist Jobs
By Oklahoma Department of Mental Health and Substance Abuse Services At Oklahoma City, OK, United States
Annual Salary is $34,500.00 plus generous benefits package!
Generous state paid benefit allowance to help cover insurance premiums
Training opportunities for CEU requirements
A wide choice of health insurance plans with no pre-existing condition exclusions or limitations
Flexible spending accounts for health care expenses or dependent care
Employee assistance programs and health and fitness programs
Utilization Review, Rn Jobs
By Med Center Health At Bowling Green, KY, United States
Case Management, Utilization Review and/or Coding experience preferred.
Three years of recent clinical Registered Nurse experience in a hospital setting required.
Graduate of a school of nursing required.
Bachelor’s degree in nursing or related field preferred.
Initiates interdisciplinary referrals when appropriate and ensures interdisciplinary referrals have occurred.
Educates internal customers on medical necessity documentation opportunities and reimbursement issues, as well as performance improvement methodologies.
Rn - Utilization Review (Evenings)
By Adelphi Medical Staffing, LLC At Lewes, DE, United States
Previous experience in Case Management including knowledge of Interqual criteria and Utilization Management. Preferred.
Knowledge And Experience With Electronic Health Records
Three to five years clinical experience.
Possess strong communication, problem solving and organizational skills.
Clear Communication Skills Both Written And Verbal
Has Skills To Provides Customer Service To Patients, Team Members And Visitors
Utilization Review Specialist Jobs
By Charlie Health At United States
Strong project management skills, with a demonstrable ability to corral and manage details in a fast-paced, fluid environment
Knowledge of all confidentially requirements regarding patients and strict maintenance of proper confidentiality on all such information.
Collaborates at a high level to problem solve on complex cases with Manager
Follows up on all outstanding authorizations and reports all barriers to Manager
Collaborates with Revenue Team and Admissions to improve patient experience from the front door through discharge
Partners with Manager and Director to troubleshoot workflows and processes to achieve efficiency gains in current and future company systems
Utilization Review Coord Jobs
By St. Jude Children's Research Hospital At Memphis, TN, United States
Three (3) years related medical experience
Six (6) months experience in a hospital environment required
Experience with InterQual guidelines and Cerner systems preferred
Utilization Review Coord - 0.8 - Days - Bhs - Service Line
By El Camino Health At , Mountain View, Ca $48.87 - $73.31 an hour
Knowledge and experience in managed care.
Advanced communication skills in advocacy, negotiation and conflict resolution; both written and verbal.
Proven critical thinking and problem-solving skills with the ability to organize, analyze and present data.
Demonstrated ability working well with patients/families, physicians, nursing and ancillary staff.
One of the following licenses:
a. Valid California LCSW license
Utilization And Billing Specialist
By Samaritan Recovery Community At Nashville, TN, United States
Prepare Utilization Management and statistical reports related to all programs for Samaritan PSO meetings
Verify client insurance coverage and benefits
Submit insurance billing information to managed care organizations, monitor payments and denials of payment
Conduct Level 1 audits in accordance with applicable agecy policy and procedure
Maintain Staff Training Log and TnCare required training for staff on Relias. Maintain training documentation on all staff members
Participate in Professional Staff Organization (PSO) meetings
Utilization Review (Ur) Specialist
By Stonington Institute At , North Stonington, 06359, Ct
Knowledge of UR processes required for all payor sources i.e. precertification, concurrent reviews, discharge review.
Complete initial precertification for all levels of care.
Collaborate with clinicians/case managers to obtain pertinent clinical and discharge information.
Liaison between insurance and clinical staff, providing information to clinicians/case managers regarding dispositions that would be approved by insurance.
Consult with Admissions Department regarding specific LOC issues, insurance requests, and/or criteria questions.
Conduct concurrent reviews on assigned cases.
Rn Utilization Review Specialist - Case Management
By Keck Medical Center of USC At , Los Angeles, 90015, Ca $47.31 - $88.00 an hour
Req 3 years Case management experience in an acute care hospital setting
Assists with denial management to identify opportunities to improve department processes
Demonstrates collaborative working relationships with case managers and payers to ensure authorizations are obtained and current.
Maintains awareness of payer/reimbursement practices and requirements.
Req 3 years Clinical experience.
Req 1 year Experience utilizing InterQual Criteria in CERME format.
Utilization Review Specialist Jobs
By MJ Resource Management At Torrance, CA, United States
Experience with PHP/IOP and SUD.
Experience working with commercial health plans.
Experience w admission and concurrent reviews.
Perform all other duties as assigned Skills:
5 years of Utilization Review.
Ability to create a sense of urgency.
Rn Utilization Review - Patient Access
By Penn State Health At , Enola, 17025, Pa
Communicates with the Medical Staff and Nursing Staff any utilization issues concerning patient care activities.
Presents Hospital Issued Notices of Non-coverage to patient/family and attending physician when patient's stay will no longer be covered by Medicare.
Acts as liaison between Hospital, physicians, patients and Medicare/Medicaid/Insurance review staff.
Performs preadmission and continued stay preauthorization for patients identified by Admissions as required this service.
Adheres to Federal and State rules as outlined.
Prepares monthly reports for review by the Medical Staff.
Utilization Review Specialist - Casual
By Nebraska Methodist Health System At , Omaha, 68118, Ne
Maintains knowledge of Payer requirements for peer to peer process, Skilled nursing facility authorization, & LTAC reviews.
Provides provider and care team ongoing education regarding utilization review/management.
Verifies authorization of services and communicates information to case management/nursing team.
Makes decisions based on evidence based practice, research, and UR nurse higher order critical thinking skills and experience.
Maintains knowledge of Payer requirements regarding length of stay for observation and transition to Inpatient
Documents actions taken and outcome(s) in Cerner Case Management tool, payer information.
Utilization Review Case Mgr-Cmc-Baybrook
By UTMB Health At , Galveston, 77555, Tx
Collaborates with care managers, providers, nursing and pharmacy to facilitate identified discharge needs and ensure services provided at destination infirmary.
Salary is commensurate with years of relevant work experience.
Monitors and facilitates appropriate utilization of resources and provides alternative options to hospital care (i.e., infirmary placement, urgent clinic).
Functions as a resource to physicians and nursing staff regarding approved criteria, specialty practice guidelines, and alternative treatment options.
Provides 24/7 access to care and care coordination through the telephone call center.
Adheres to internal controls established for department.

Are you looking for an exciting opportunity to use your clinical and administrative skills to help ensure quality patient care? We are looking for a Utilization Review Specialist to join our team and help us provide the best care possible. As a Utilization Review Specialist, you will be responsible for reviewing and analyzing patient medical records to ensure that services are medically necessary and meet the standards of care. You will also be responsible for providing guidance and support to providers and staff to ensure compliance with regulatory requirements. If you are looking for a challenging and rewarding position, this is the job for you!

Overview:

A Utilization Review Specialist is responsible for ensuring that health care services are provided in an efficient and cost-effective manner. They review medical records and other documentation to determine the appropriateness of services provided and to ensure that services are in compliance with applicable regulations. Utilization Review Specialists also provide guidance to health care providers on the most cost-effective and appropriate treatments for their patients.

Detailed Job Description:

Utilization Review Specialists are responsible for reviewing medical records and other documentation to ensure that health care services are provided in an efficient and cost-effective manner. They evaluate the appropriateness of services provided and ensure that services are in compliance with applicable regulations. Utilization Review Specialists also provide guidance to health care providers on the most cost-effective and appropriate treatments for their patients. They may also be responsible for developing and implementing utilization review plans, policies, and procedures.

What is Utilization Review Specialist Job Skills Required?

• Knowledge of medical terminology and coding
• Knowledge of health care regulations and standards
• Ability to analyze medical records and other documentation
• Ability to interpret and apply regulations and standards
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Strong organizational and problem-solving skills
• Computer proficiency

What is Utilization Review Specialist Job Qualifications?

• Bachelor’s degree in health care administration, health information management, or a related field
• Certification in utilization review (preferred)
• At least two years of experience in utilization review or a related field

What is Utilization Review Specialist Job Knowledge?

• Knowledge of medical terminology and coding
• Knowledge of health care regulations and standards
• Knowledge of utilization review plans, policies, and procedures

What is Utilization Review Specialist Job Experience?

• At least two years of experience in utilization review or a related field

What is Utilization Review Specialist Job Responsibilities?

• Review medical records and other documentation to ensure that services are provided in an efficient and cost-effective manner
• Evaluate the appropriateness of services provided and ensure that services are in compliance with applicable regulations
• Provide guidance to health care providers on the most cost-effective and appropriate treatments for their patients
• Develop and implement utilization review plans, policies, and procedures
• Monitor utilization review activities to ensure compliance with applicable regulations
• Maintain accurate records of utilization review activities