Register
Recruit Create CV

Utilization Review Asst Jobs in Fort Bend, Texas

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
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
Admin Asst Iv - Review And Release Processing
By Texas Department Of Criminal Justice At Houston, TX, United States
Telephonic Interviews Will Not Be Accepted
Work Site Visits Will Not Be Conducted
Graduation from an accredited senior high school or equivalent or
Three years full-time, wage-earning customer service, clerical,
Must have or be able to obtain a certificate of course completion
The salary for an ERS Retiree (or non-contributing member) will
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.
Admin Asst Ii - Review And Release Processing
By Texas Department Of Criminal Justice At Austin, TX, United States
Telephonic Interviews Will Not Be Accepted
Work Site Visits Will Not Be Conducted
Graduation from an accredited senior high school or equivalent or
One year full-time, wage-earning customer service, clerical,
Must have or be able to obtain a certificate of course completion
The salary for an ERS Retiree (or non-contributing member) will
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.
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.
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
Utilization Review Specialist Jobs
By Medical Center Hospital At , Odessa, 79761, Tx

Holds a current Texas license as a Registered Nurse.

Utilization Review Coordinator Jobs
By BENEFIT MARKETING ALLIES CORP. At , Austin, 78701, Tx

Position Description: ROLE AND RESPONSIBILITIES Communication with Providers regarding Pre-Authorization Requests. Provider Outreach Calls to retrieve Medical Records. Maintaining HIPAA Compliant ...

Utilization Review Nurse Jobs
By Methodist McKinney Hospital At , Mckinney, 75070, Tx
Uses knowledge of the nursing process and pathophysiology to interpret the needs or requirements of patients
Identifies, documents and communicates potential quality assurance or risk management issues as appropriate.
Uses knowledge of nursing process and pathophysiology to anticipate discharge needs.
Licensure as a registered nurse required.
Performs initial, concurrent, discharge and retrospective reviews.
Uses evidence-based medical guidelines to determine the medical appropriateness of inpatient and outpatient services
Utilization Review Specialist Jobs
By Lexington Medical Center At , West Columbia, 29169, Sc
Communicates with case management triad regarding reimbursement issues.
We are committed to offering quality, cost-effective benefits choices for our employees and their families:
Manages inpatient Medicare discharge expedited appeals process through the QIO.
Indentifies abnormal patterns of utilization and refers to Manager/Director.
Day ONE medical, dental and life insurance benefits
Exhibits commitment and pride through personal example by positively speaking about LMC, the department, employees and guests.
Utilization Review Rn (Prn Case Management) Montgomery Medical Center
By MEDSTAR HEALTH At , Olney, 20832, Md $35 - $50 an hour

Pay: $35.00 - $50.00 per hour

Utilization Review Nurse Jobs
By INTEGRANET HEALTH At , Houston, Tx
Preferred knowledge in case management principles, utilization management procedures and practices
Prior experience with Utilization Management
Provides telephonic case management, referral of resources, education and other clinically based activities to plan member.
QUALIFICATIONS, SKILLS, ABILITIES AND PROFESSIONAL COMPETENCIES:
Experience with Health Plans and Managed Care
Previous training and demonstrated competence in negotiations, quality assurance and case management outcomes
Case Management Utilization Review Rn
By Steward Health Care At , Dallas, 75201, Tx
Collaborates with the multidisciplinary team to assist patient with benefits management.
Leadership skills required for role include effective mentoring, coaching, counseling, time management, problem solving, and strategic planning.
Experience (Type & Length): Three to five years of acute medical/surgical experience plus three to five years of Case Management experience.
Certification/Licensure: RN license required; Certification in Case Management (CCM) strongly preferred.
The Care Manager works collaboratively with all healthcare disciplines to assure appropriate and timely services.
Adaptability to change and good organizational skills required. Ability to read and communicate effectively in English.
Utilization Review Specialist Jobs
By Memorial Hermann Health System At , Houston, 77024, Tx
Experience / Knowledge / Skills
Refers cases and issues to Care Management Medical Director in compliance with Department procedures and follows up as indicated.
Effective oral and written communication skills.
Utilizes conflict resolution skills as necessary to ensure timely resolution of issues.
Uses appropriate criteria sets for admission reviews, continuing stay reviews, outlier reviews and clinical appropriateness recommendation.
Takes appropriate follow-up action when established criteria for utilization of services are not met.
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 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 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.

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.
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
Utilization Review Case Manager
By Lehigh Valley Health Network At , Allentown, 18103
2 years Knowledge of utilization management as it relates to third party payers.
5 years of experience in case management and DC planning experience within the last 5 years.
Knowledge, Skills, and Abilities - Required:
Knowledge, Skills, and Abilities - Preferred:
2 years of previous utilization review experience. and
3 years of experience in acute care and
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.
Outcomes Manager - Utilization Review - Behavioral Health (Remote)
By VIRTUA At , Marlton, 08053, Nj
Appropriate and complete documentation of clinical review and denial management in the case management documentation system and in the billing system.
Position Qualifications Required / Experience Required:
Manages the concurrent denial process by referring to appropriate resource for concurrent and retrospective appeal activity process.
Understands and applies applicable federal and state requirement.
Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity.
Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues.
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.