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Utilization Review Rn Jobs

Senior Therapist - Youth Clinical Utilization Review
By City of Alexandria, VA At , Alexandria $66,460 - $89,027 a year
Implement Independent Assessment Certification & Coordination Team (IACCT) recommendations including locating residential treatment placements and intensive community based services;
Act as Family Assessment and Planning Team (FAPT) Case Manager for high needs youth and their families;
Engage families seeking residential services for their children in the Children’s Services Act (CSA) Parental Agreement process;
Provide consultation, coordination and monitoring when out-of-home behavioral health services are considered, including Parental Agreements;
Participate in multi-disciplinary planning meetings, court hearings, and relevant training, conferences and workshops;
Develop and monitor treatment plans with youth and their families based on their strengths, needs, preferences, and goals;
Utilization Review Specialist Jobs
By Department of Behavioral Healt At , Washington, Dc $87,339 - $111,749 a year
Traffic record check (as applicable);
Consumer credit check (as applicable);
Reasonable suspicion drug and alcohol test; and
Post-accident or incident drug and alcohol test.
RESIDENCY PREFERENCE AMENDMENT ACT OF 1988
Bachelor’s Degree in Nursing preferred.
(F/T) - Utilization Review (Non-Rn) Case Manager - Umhc/Sccc - Miami
By University of Miami At , Miami, Fl
Accurate review of coverage benefits and limitations to determine continued appropriateness of services requested
Maintains knowledge regarding payer reimbursement policies and clinical guidelines.
Minimum of 2 years of relevant experience
Adhere and perform timely reviews for services requiring an authorization for continuation of care
Follows the authorization process using established criteria as set forth by the payer or clinical guidelines
Facilitates interdepartmental communication regarding status of continued authorization in advance of patient’s appointment.
Medicaid Utilization Review Analyst
By State of Idaho Employment At Greater Idaho Falls, United States
An opportunity for student loan forgiveness (https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service)
an opportunity for student loan forgiveness (https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service)
THIS ANNOUNCEMENT WILL BE OPEN UNTIL FILLED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE TO BE CONSIDERED.
Generous vacation and sick leave accrual beginning as soon as you start
11 paid holidays a year
Multiple savings plans, optional 401K, and optional 457
Utilization Review Specialist(Ft)
By Cornerstone of Recovery At , Louisville, 37777, Tn
Notify supervisor when pre-certification is denied.
Develop collaborate relationships with third party payers and managed care companies
Continue education with new information regarding criteria for various insurance companies.
Track how particular Managed Care Companies approve residential days in keeping with progress notes under our ASAM criteria.
Average to above average computer skills.
Above average verbal and writing skills.
Utilization Review Business Support Specialist
By Allegheny Health Network At , , Pa
Investigates concerns for improper billing/coding practices and recommends corrective action, works collaboratively to understand denial/appeal management process and alert edits/rejections. (10%)
Proficient with department software, analytical tools, basic coding and billing knowledge, and revenue cycle operational policies. (5%)
1 year experience with medical necessity appeals
Implements and organizes downgrades compliantly and per documentation. (10%)
Identifies trends with claim holds and denials and provides communication to all necessary parties. (10%)
Communicates with all parties in a professional manner to alert of specific problem issues. (10%)
Care Review Clinician, Inpatient Review (Rn) - Mississippi
By Molina Healthcare At , Starkville, Ms $26.41 - $51.49 an hour

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

To all current Molina employees:

Medical Review Rn -Experienced - Home Or Office Based
By Qlarant At Dallas, TX, United States
Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
ICD-9 coding, CPT coding, and knowledge of Medicare and/or Medicaid regulations preferred. CPC or similar certification preferred.
Completes desk review or field audits to meet applicable contract requirements and to identify evidence of potential overpayment or fraud.
Consults with Benefit Integrity investigation experts and pharmacists for advice and clarification.
Responsible for case specific or plan specific data entry and reporting.
Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data.
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.
Benefit Review Rn Jobs
By Imagine360 At United States
Superior time management and multi-tasking skills
Staffs medically complex cases with the Supervisor of Case Management, designee, or Medical Director as directed.
Provides requested diagnosis/prognosis reports and stop loss reports that are received via Medical Management department requests.
Reviews high dollar pharmacy reports to identify appropriate referrals to Case Management or other Medical Management Services.
Assess and review current treatment history to identify appropriate referrals to Case Management Program or other Medical Management Services.
Consistently follows department Benefit Review policies and procedures to complete the review processes.
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).
Clinical Reviewer (Utilization Review - Rn) - Remote Within Florida
By Acentra Health At Tampa, FL, United States
Do you value care management and quality improvement?
Are you an experienced Clinical Reviewer looking for a new challenge?
Performs ongoing reassessment of review process to offer opportunities for improvement and/or change.
Active unrestricted RN applicable State and/or Compact State clinical license per contract requirements.
Knowledge of current NCQA/URAC standards strongly preferred.
Medical record abstracting skills required.
Utilization Management Rn (Remote)
By Better Health Group At Orlando, FL, United States
Establishing Care Management accountabilities and holding those resources accountable
Use effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to:
Two years of prior experience with Utilization Management.
Previous training and demonstrated competence in negotiations, Quality Assurance, and Case Management outcomes.
CCM certification is a plus.
Ability to successfully manage conflict, negotiating “win-win” solutions.
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.
Remote Appeals/ Utilization Review Rn
By The Judge Group At United States
Format review in accordance with the specific formatting requirements.
Utilization Review exp is helpful, not required - Critical thinking skills more important
The Judge Group is currently seeking a Remote Utilization Review RN for a great healthcare client!!
This job will have the following responsibilities:
Support the clinical aspects of the review process.
Resolve operational issues arising in connection with the clinical aspects of review cases.