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Utilization Review Appeals Specialist Jobs

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
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.
Appeals Specialist - Cgs Administrators
By BlueCross BlueShield of South Carolina At Knoxville Metropolitan Area, United States
Two years of job experience in a related field.
Excellent computer skills with the ability to navigate between multiple software platforms and work on multiple computer screens.
Medical claims processing, appeals, billing, or coding experience.
Our Comprehensive Benefits Package Includes
Work hours during training: 7:30 am to 4:00 pm CT Monday through Friday
Work hours following training: You can start your eight-hour shift between the hours of 5:00 am and 9:00 am CT.
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 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.
Review & Appeals Specialist I
By National Commission on Certification of Physician Assistants (NCCPA) At Johns Creek, GA, United States
Your highly developed time management skills, systematic approach to organization/planning and keen attention to detail.
Maintain ongoing knowledge regarding NCCPA organizational policies, departmental policies, standard operating procedures, operational guidelines, business rules, reports and audit tools.
Your proven analytical approach and proactive problem-solving skills that identify and recommend solutions to the determined issues.
Your excellent written and verbal communications skills with a proficiency in diplomacy and confidentiality.
Your proven ability to manage competing priorities and accomplishing tasks within the agreed upon timeframe.
At least two years of professional experience in business, healthcare, appeals & grievances, state medical board or legal field.
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.
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.
Discharge Planner-Utilization Review Jobs
By Valley Health System Consolidated Services At , Las Vegas, 89117, Nv $20.52 - $27.19 an hour
Comprehensive education and training center
Competitive Compensation & Generous Paid Time Off
Excellent Medical, Dental, Vision and Prescription Drug Plans
401(K) with company match and discounted stock plan
Career opportunities within VHS and UHS Subsidies
Challenging and rewarding work environment
Supervisor - Utilization Review: Corp - Utilization Review
By Memorial Healthcare System At , Hollywood, Fl
Monitors department operations, including information technologies, service level determination and complaint management, to achieve performance and quality control.
MANAGING PEOPLE: Uses HR/Performance Management processes and systems to align individual performance to achieve organizational results.
Assists UR Director in planning and monitoring staffing activities, including hiring, orienting, evaluating, disciplinary actions and continuing education initiatives.
ANALYSIS AND DECISION MAKING: Uses decision making processes and tools to analyze situations and make effective decisions.
EFFECTIVE COMMUNICATION: Communicates effectively with various audiences using the most appropriate method for the situation.
Lifting or Carrying 0 - 25 lbs Non-Patient 60.00%
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
Expedited Appeals Specialist- Remote
By ConnectiCare At , New York, Ny $72,000 - $138,000 a year
Relevant Work Experience, Knowledge, Skills, and Abilities
Extensive knowledge and experience in claims, enrollment, benefits, and member contracts. (R)
Excellent prioritizing, organizing, time management, problem solving and analytical skills. (R)
Provide recommendations to management regarding issue resolution, root cause analysis and best practices.
Additional related experience/specialized training may be considered in lieu of degree requirements. (R)
Exceed median production and compliance standards for both case resolution and data requirements.
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.
Supervisor - Utilization Review: Corp - Utilization Review
By Memorial Healthcare System At Hollywood, FL, United States
Monitors department operations, including information technologies, service level determination and complaint management, to achieve performance and quality control.
MANAGING PEOPLE: Uses HR/Performance Management processes and systems to align individual performance to achieve organizational results.
Assists UR Director in planning and monitoring staffing activities, including hiring, orienting, evaluating, disciplinary actions and continuing education initiatives.
ANALYSIS AND DECISION MAKING: Uses decision making processes and tools to analyze situations and make effective decisions.
EFFECTIVE COMMUNICATION: Communicates effectively with various audiences using the most appropriate method for the situation.
Lifting or Carrying 0 - 25 lbs Non-Patient 60.00%

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