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Utilization Review Coordinator Jobs in Dallas, Texas

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.
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.
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
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
Medical Review Coordinator Jobs
By AllMed Healthcare Management At Portland, Oregon Metropolitan Area, United States
Who is AllMed Healthcare Management?
Outstanding interpersonal, teamwork, and verbal communication skills.
Excellent computer skills in a Microsoft Windows environment and the ability to pick up new software programs.
Excellent benefits to keep you healthy with medical, dental, vision, life, and disability insurance, plus company paid parking or monthly transit.
minimum of 1 year of related experience
Ensure accurate and efficient compression and organization of medical records to eliminate duplicate and extraneous information for peer reviewers.
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.
Medical Review Coordinator (Intake Coordinator)
By AllMed Healthcare Management At Portland, Oregon Metropolitan Area, United States
Who is AllMed Healthcare Management?
Outstanding interpersonal, teamwork, and verbal communication skills.
Excellent computer skills in a Microsoft Windows environment and the ability to pick up new software programs.
Excellent benefits to keep you healthy with medical, dental, vision, life, and disability insurance, plus company paid parking or monthly transit.
Ensure accurate and efficient compression and organization of medical records to eliminate duplicate and extraneous information for peer reviewers.
Prepare and organize clinical information and review criteria for peer review.
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 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 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
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.
Case Review Coordinator Jobs
By Brigham & Women's Faulkner Hospital(BWFH) At , Boston, 02130, Ma
3 year of Utilization Review and Case Management experience required, 4 or more years preferred
Provide to the patient representative the Acknowledgement of disclosure ,obtain choices of post acute facilities or service and signature
Perform utilization review to evaluate for appropriate level of care and faxes all insurance reviews timely to prevent denials.
Collaborate with patient/family and interdisciplinary team to assess for appropriate discharge needs.
Place and implement all aspects of referrals to all levels of post acute care in 4 Next.
Online documentation of interaction with patient, family and interdisciplinary team.
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 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
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.
Utilization Review Coordinator Wfh
By HCA Healthcare At Nashville, TN, United States
Education assistance (tuition, student loan, certification support, dependent scholarships)
Family support through fertility and family building benefits with Progyny and adoption assistance.
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
Manage Midas Send Payor Non-response and no authorization documented worklist rules and document appropriately
Demonstrate knowledge and effective use of multiple applications, systems and resources
Greater than 2 years' work experience in a healthcare setting required

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