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Utilization Review Assistant Jobs in Fremont, Iowa

Utilization Review Rn (Austin, Texas)
By Ascension At , Remote From $69,555 a year
Provide case management and/or consultation for complex cases.
Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
Schedule: Full-Time, 8-hour day shift, Monday - Friday, Fully Remote
Facility: Automated Benefit Services (ABS)
Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
Knowledge of Government Insurance Prgram plans.
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
Licensed Utilization Review I (Contract)
By Elevance Health At , Remote
Knowledge of the medical management process strongly preferred.
Applies clinical knowledge to work with facilities and providers for care coordination.
Educates the member about plan benefits and contracted physicians, facilities and healthcare providers.
Refers treatment plans/plan of care to peer clinical reviewers in accordance with established criteria/guidelines and does not issue medical necessity non-certifications.
Facilitates accreditation by knowing, understanding, and accurately applying accrediting and regulatory requirements and standards.
Develops relationships with physicians, healthcare service providers, and internal and external customers to help improve health outcomes for members.
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 Nurse - Lvn/Lpn
By HealthComp At , Remote
1 year of recent experience in Utilization Review or Utilization Management at a health plan or other managed care organization preferred.
2-3 years clinical nursing experience required.
Authorized to work in the US
Utilization Review Coordinator Jobs
By HealthComp At , Remote $20 - $28 an hour
Perform clerical/administrative duties in the utilization and case management department.
Accurate data entry skills (40wpm)
Full offering of health and wellness benefits for you and your family
Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis.
Strong written and verbal communication skills
Excellent interpersonal and communication skills
Director Of Admission & Utilization Review
By Recovery Centers of America At , Greenville, 29615, Sc
Knowledge of pre-assessment and pre-certification reviews and able to perform appeal reviews.
Ability to work as a member of a management team.
Knowledge and experience of all continuums of care, including admission assessment and continued stay criteria
Ensures compliance with accreditation agency requirements.
Ensures compliance with the state requirements/guidelines.
Knowledge of discharge planning resources.
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 Coordinator: Rn Or Msw
By The Carolina Center for Behavioral Health At , Greer, 29650
Maintain appropriate records of the Utilization Review Department.
Conducts admission reviews and pre-certs.
Conducts concurrent and extended stay reviews.
Prepares and submits appeals to third party payors.
Participates in activities which enhance professional growth and development.
Demonstrates conduct in keeping with CCBH’s ethical standards.
Director Patient Access And Utilization Review
By Children's Healthcare of Atlanta At , Brookhaven, 30329

Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Day ...

Utilization Review Rn Jobs
By TidalHealth At Salisbury, MD, United States
Strong analytical, data management and PC skills
Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement
3 or more years of strong clinical experience
Excellent interpersonal communication and negotiation skills
Utilization Review RN Position Requirements
Current and valid license to practice as a RN
Utilization Review Jobs
By CodeMax Medical Billing At Los Angeles, CA, United States

The Utilization Review Specialist will perform utilization review of pre-certification and concurrent clinical utilization reviews with insurance companies in accordance with certification ...

Medicaid Utilization Review Analyst
By State of Idaho At , Coeur D'alene $26 an hour
(PERSI) that offers a lifetime benefit.
Excellent medical, dental and vision insurance- (full-time) employee only coverage for PPO $65/month for medical and vision & $11.00/month for dental
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
An opportunity for student loan forgiveness
Utilization Review Representative Jobs
By Ethos At Dallas, TX, United States
Receives, screens and manages mail, faxes and calls.
Collection and data entry of structured clinical data (including diagnosis, diagnosis codes, procedures, procedure codes).
Reviews service request for completeness of information.
Assigns reviews to Utilization Review Nurse
Assists with written determination letter communications via fax, e-mail or written mail under.
Maintains confidentiality and security in all aspects of performance.
Social Worker Msw - Utilization Review
By Providence At , Napa, 94581
1 year experience as a Social Worker or Counselor.
Check out our benefits page for more information about our Benefits and Rewards.
Master's Degree in Social Work or Counseling Psychology.
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.

Utilization Review Specialist Jobs
By St. Charles Health System At , Bend, 97701 $24.32 - $33.44 an hour
Intermediate to advanced proficiency in Microsoft applications (Word, Excel and Access), database management, and document preparation
REPORTS TO POSITION: Manager, Utilization Review
Required: 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.
DATE LAST REVIEWED: March 9, 2023
Rn Specialist Utilization Review
By HonorHealth At , Scottsdale, 85258
Determines qualifications for hospital level of care based on set criteria.
Initiates chart reviews, conducts follow-up reviews, and escalates secondary reviews to Physician Advisor as necessary.
Performs other duties as assigned.
Assistant Planner-Site Plan Review
By City of Houston, TX At , Houston, 77002 $49,539 - $53,710 a year
Performs routine administrative tasks in designated planning program areas; including data entry, file management, and responding to customer inquiries.
Works closely with the public on basic planning programs, requirements, or ordinances
Reviews, or assists in reviewing, development proposals of limited complexity for compliance with applicable regulations
Provides technical assistance and professional support in the administration of specific planning programs, regulations, or ordinances.
Researches and compiles information on a variety of planning issues from multiple sources.
Prepares maps and other graphical representations of data of varying complexity.
Utilization Review Director Jobs
By Coastal Behavioral Health At , Savannah, 31406
Challenging and rewarding work environment
Excellent Medical, Dental, Vision and Prescription Drug Plan
401(K) with company match and discounted stock plan
Career development opportunities within UHS and its 300+ Subsidiaries
Utilization Review Business Support Specialist
By Allegheny Health Network At , Up to $30.93 an hour
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%)
Rn Utilization Review Jobs
By Edward-Elmhurst Health At , Naperville, 60540
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
Minimum of two years of utilization review and/or clinical experience
Minimum of two years of utilization review experience
Associate’s Degree or higher in Nursing
Current State of Illinois Registered Nurse licensure
Bachelor’s Degree in Nursing or health care related field