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Utilization Review Coordinator Jobs in Ohio

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 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 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
(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.
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.
Registered Nurse Coordinator - Utilization Review Clinical Care Management
By St. Joseph's Health At , Syracuse, 13203, Ny
Maintain the prescribed workload including work queue management, process oversight and committee responsibilities.
Education, Training, Experience, Certification and Licensure:
Participating in Revenue Cycle functions including work queue and account management, monitoring metrics, and attendance at meetings.
Participate in interdisciplinary meetings regarding UR and denials management, including retroactive chart reviews, data collection, and process development.
Maintain BLS/CPR certification. Maintain other certifications appropriate to field.
Career advancement to senior leadership roles such as Manager, Director or Administrative roles.
Utilization Review Assistant - Remote Opportunity
By Martin's Point Health Care At , Portland, Me
Basic knowledge of medical terminology, current healthcare benefits and managed care insurance plans
Participates in and contributes to Health Management Department meetings and process improvement initiatives.
Associates Degree or equivalent combination of education and experience
2 years of managed care experience including experience in a call center
Manages the authorization review queues including monitoring for timeliness of responses.
Manages fax queues including uploading faxes to the UM authorization system.
Rn, Utilization Review Jobs
By Cincinnati Children's Hospital At , Cincinnati, 45219, Oh $30.91 - $38.92 an hour
Case Management Certification through CCM or ACMA
3 or more years of inpatient RN experience
BSN from ACEN, CCNE or NLN CNEA accredited institution or MSN
Active Ohio RN License. May be required to obtain other state licensure.
Rn, Utilization Review - Remote | Wfh
By Get It Recruit - Healthcare At Cincinnati, OH, United States

We're looking for a talented Utilization Review Nurse to join our team! As a Utilization Review Nurse, you'll use your skills and expertise to help us manage the cost of health care benefits and ...

Continuing Care Utilization Review Coordinator Rn
By Kaiser Permanente At , Walnut Creek, 94598, Ca $71.25 - $92.17 an hour
Must be able to work in a Labor/Management Partnership environment.
Minimum one (1) year of utilization experience required.
Bachelors degree in nursing or health related field required, OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
Demonstrated knowledge of diagnostic codes.
Conducts utilization review for in-house patients and/or members who have been admitted to contracted facilities. Interviews patients/caregivers regarding care after hospitalization.
Rn - Case Manager I - Utilization Review
By The University of Mississippi Medical Center At , Jackson, 39216, Ms
Please complete this application in entirety by providing all of your work experience, education and certifications/
Drives appropriate policy/practice change through research, knowledge, and skills.
Management retains the right to add or change duties at any time.
You must meet all of the job requirements at the time of submitting the application.
Works to manage patient flow and safety to assure appropriate throughput, contributing to organizational financial wellbeing.
You can only apply one time to a job requisition.

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