Register
Recruit Create CV

Utilization Review Asst Jobs in Texas

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.
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
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 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
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.