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Utilization Review Appeals Specialist Jobs in Idaho

Utilization Review Clinical Specialist (Remote)
By CHS Corporate At , Franklin, 37067

Computer Skills Required: Data entry skills; Demonstrable skills with Google Docs, Google Sheets, and email applications.

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

Are you looking for an exciting new challenge in the healthcare industry? We are looking for a motivated and experienced Utilization Review Appeals Specialist to join our team. You will be responsible for reviewing and resolving appeals for medical services, ensuring that all appeals are handled in a timely and accurate manner. If you have excellent communication and problem-solving skills, and a passion for helping people, this could be the perfect job for you!

Overview:

A Utilization Review Appeals Specialist is responsible for ensuring that health care services are provided in accordance with established standards and regulations. They review appeals from providers and patients regarding denied services and make decisions based on the evidence presented. They also provide guidance to providers and patients on the appeals process and ensure that all appeals are handled in a timely manner.

Detailed Job Description:

Utilization Review Appeals Specialists are responsible for reviewing appeals from providers and patients regarding denied services. They must review the evidence presented and make decisions based on the evidence. They must also provide guidance to providers and patients on the appeals process and ensure that all appeals are handled in a timely manner. They must also ensure that health care services are provided in accordance with established standards and regulations.

What is Utilization Review Appeals Specialist Job Skills Required?

• Excellent communication and interpersonal skills
• Strong analytical and problem-solving skills
• Ability to work independently and as part of a team
• Knowledge of health care regulations and standards
• Ability to make decisions based on evidence
• Knowledge of the appeals process

What is Utilization Review Appeals Specialist Job Qualifications?

• Bachelor’s degree in health care administration, business administration, or a related field
• At least two years of experience in utilization review or appeals
• Knowledge of health care regulations and standards
• Ability to make decisions based on evidence
• Excellent communication and interpersonal skills

What is Utilization Review Appeals Specialist Job Knowledge?

• Knowledge of health care regulations and standards
• Knowledge of the appeals process
• Knowledge of medical terminology
• Knowledge of medical coding

What is Utilization Review Appeals Specialist Job Experience?

• At least two years of experience in utilization review or appeals
• Experience in health care administration, business administration, or a related field

What is Utilization Review Appeals Specialist Job Responsibilities?

• Review appeals from providers and patients regarding denied services
• Provide guidance to providers and patients on the appeals process
• Ensure that all appeals are handled in a timely manner
• Ensure that health care services are provided in accordance with established standards and regulations
• Make decisions based on the evidence presented