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Utilization Review Coordinator Jobs

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 ...

Provider Utilization Coordinator Sr
By QTC Management, Inc. At , San Antonio, 78228 $21 - $23 an hour
Experience utilizing EMR or case management software
Effective management of electronic confirmation systems (i.e. eMessenger, Pega communicator, ACD) in order to minimize no show rates
Excellent data entry and typing skills
Ability to coordinate with regional utilization manager (RUM) on IPA utilization issues
Efficiently utilizes electronic tools and workflows in order to manage resources such as: ECW, UCM, eProcess and other tools as necessary
Excellent communication skills in English, both written and verbal
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.
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.
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
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%)
Team Coordinator, Behavioral Health Utilization Review
By Sentara Healthcare At , Norfolk, 23502
Provides educational services to the Utilization Management staff
Requires knowledge of managed care contracting, Medical Necessity, CMHRS services, DMAS protocols, clinical protocols and clinical review requirements
Minimum 1 year experience in Managed Care Setting (MCO)
First line supervisor in the Utilization Management Department
Provides a leadership role in ongoing utilization review competency assessment, needs identification and educational offerings
Requires knowledge of contractual, regulatory and compliance requirements for government payers, self funded and commercial payers
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
Dental Claim Review Coordinator
By MetLife At United States
Good time management and organization skills.
5 years of Dental Claims Knowledge and Experience
EDI Experience and Knowledge/ Knowledge of Provider procedures and systems
Manages critical relationships with IT, consultants/vendors, internal end users, business leaders and customers.
Prepare cost benefit analysis of proposed enhancements/efficiencies for new projects when required.
Excellent oral and written communication skills.
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.
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 a challenging and rewarding career in Utilization Review? We are seeking an experienced Utilization Review Coordinator to join our team. You will be responsible for ensuring that all utilization review activities are conducted in accordance with established policies and procedures. You will also be responsible for coordinating and monitoring the utilization review process, providing timely and accurate information to providers, and ensuring that all utilization review activities are completed in a timely and accurate manner. If you are an experienced Utilization Review Coordinator with a passion for providing quality care, we want to hear from you!

Overview:

A Utilization Review Coordinator is responsible for ensuring that health care services are provided in a cost-effective and appropriate manner. They review medical records and other documentation to determine if services are medically necessary and if they meet the criteria for coverage. They also provide guidance to providers and patients regarding the utilization of services.

Detailed Job Description:

The Utilization Review Coordinator is responsible for reviewing medical records and other documentation to determine if services are medically necessary and if they meet the criteria for coverage. They also provide guidance to providers and patients regarding the utilization of services. They must be knowledgeable of the various insurance plans and their coverage requirements. They must also be able to interpret medical records and other documentation to determine if services are medically necessary and if they meet the criteria for coverage. They must be able to communicate effectively with providers and patients to ensure that services are provided in a cost-effective and appropriate manner.

What is Utilization Review Coordinator Job Skills Required?

• Knowledge of insurance plans and their coverage requirements
• Ability to interpret medical records and other documentation
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Ability to prioritize tasks and manage multiple projects
• Knowledge of medical terminology
• Knowledge of coding and billing procedures

What is Utilization Review Coordinator Job Qualifications?

• Bachelor’s degree in health care administration, nursing, or a related field
• Previous experience in utilization review or a related field
• Certification in utilization review (preferred)

What is Utilization Review Coordinator Job Knowledge?

• Knowledge of insurance plans and their coverage requirements
• Knowledge of medical terminology
• Knowledge of coding and billing procedures
• Knowledge of utilization review processes

What is Utilization Review Coordinator Job Experience?

• Previous experience in utilization review or a related field
• Experience working with insurance companies and providers

What is Utilization Review Coordinator Job Responsibilities?

• Review medical records and other documentation to determine if services are medically necessary and if they meet the criteria for coverage
• Provide guidance to providers and patients regarding the utilization of services
• Communicate effectively with providers and patients to ensure that services are provided in a cost-effective and appropriate manner
• Monitor utilization of services to ensure compliance with insurance plans
• Maintain accurate records of utilization review activities