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Utilization Review Coordinator Jobs

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
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 MTR TREATMENT CORP At United States
Function as a member of the Billing Team to ensure that all daily responsibilities are met.
Aid in verification of benefits when needed.
Excellent verbal and written communication skills.
Prior Utilization Review experience in a Substance abuse environment.
Knowledge of ASAM and medical necessity guidelines as it relates to substance abuse.
The Utilization Review Specialist will perform pre-certification reviews, concurrent reviews and discharge reviews for substance abuse facilities.
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.
Utilization Review Rn Jobs
By Saint Luke's Health System At Kansas City, MO, United States

The best place to get care. The best place to give care

Utilization Review Coordinator Jobs
By Meadows Behavioral Healthcare At United States
Conduct reviews to ensure that services and documentation conform to the facility protocols, and the requirements of third party payer sources.
Bachelor/Associates Degree in Nursing preferred or related job experience
Registered Nursing licensure/certification in good standing (RN) CPR Certification optional.
Prefer a minimum of two years experience in a psychiatric setting or behavioral health utilization review.
Knowledge of medical terminology, psychiatric interventions and medications and insurance is essential to this position.
Maintain cumulative documentation regarding actions taken during the UR process.
Aba Utilization Review (Ur) Specialist
By Spectrum Billing Solutions At Skokie, IL, United States
Manage authorization denials including referral for peer review.
Assist the treatment team in understanding payer requirements for admission, continued stay and discharge planning.
3-5 years of related ABA, Substance Abuse, and/or Mental Health experience.
Superior written and oral communication skills
Solid understanding of insurance benefits and coverages.
Strong computer skills (Word, Excel, billing software).
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.
Utilization Review Specialist Jobs
By Oklahoma Department of Mental Health and Substance Abuse Services At Oklahoma City, OK, United States
Annual Salary is $34,500.00 plus generous benefits package!
Generous state paid benefit allowance to help cover insurance premiums
Training opportunities for CEU requirements
A wide choice of health insurance plans with no pre-existing condition exclusions or limitations
Flexible spending accounts for health care expenses or dependent care
Employee assistance programs and health and fitness programs
Utilization Review, Rn Jobs
By Med Center Health At Bowling Green, KY, United States
Case Management, Utilization Review and/or Coding experience preferred.
Three years of recent clinical Registered Nurse experience in a hospital setting required.
Graduate of a school of nursing required.
Bachelor’s degree in nursing or related field preferred.
Initiates interdisciplinary referrals when appropriate and ensures interdisciplinary referrals have occurred.
Educates internal customers on medical necessity documentation opportunities and reimbursement issues, as well as performance improvement methodologies.
Remote Appeals/ Utilization Review Rn
By The Judge Group At United States
Format review in accordance with the specific formatting requirements.
Utilization Review exp is helpful, not required - Critical thinking skills more important
The Judge Group is currently seeking a Remote Utilization Review RN for a great healthcare client!!
This job will have the following responsibilities:
Support the clinical aspects of the review process.
Resolve operational issues arising in connection with the clinical aspects of review cases.
Rn - Utilization Review (Evenings)
By Adelphi Medical Staffing, LLC At Lewes, DE, United States
Previous experience in Case Management including knowledge of Interqual criteria and Utilization Management. Preferred.
Knowledge And Experience With Electronic Health Records
Three to five years clinical experience.
Possess strong communication, problem solving and organizational skills.
Clear Communication Skills Both Written And Verbal
Has Skills To Provides Customer Service To Patients, Team Members And Visitors
Utilization Review Specialist Jobs
By Charlie Health At United States
Strong project management skills, with a demonstrable ability to corral and manage details in a fast-paced, fluid environment
Knowledge of all confidentially requirements regarding patients and strict maintenance of proper confidentiality on all such information.
Collaborates at a high level to problem solve on complex cases with Manager
Follows up on all outstanding authorizations and reports all barriers to Manager
Collaborates with Revenue Team and Admissions to improve patient experience from the front door through discharge
Partners with Manager and Director to troubleshoot workflows and processes to achieve efficiency gains in current and future company systems
Utilization Review Coord Jobs
By St. Jude Children's Research Hospital At Memphis, TN, United States
Three (3) years related medical experience
Six (6) months experience in a hospital environment required
Experience with InterQual guidelines and Cerner systems preferred
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 Coord - 0.8 - Days - Bhs - Service Line
By El Camino Health At , Mountain View, Ca $48.87 - $73.31 an hour
Knowledge and experience in managed care.
Advanced communication skills in advocacy, negotiation and conflict resolution; both written and verbal.
Proven critical thinking and problem-solving skills with the ability to organize, analyze and present data.
Demonstrated ability working well with patients/families, physicians, nursing and ancillary staff.
One of the following licenses:
a. Valid California LCSW license
Health Care Utilization Review Coordinator (Hurc Ii) - Continuum Of Care
By University of Illinois At , Chicago, 60607, Il
Five years (60 months) of RN experience.
Current AHA BLS/CPR and other required unit specific certifications
Effective communication skills (oral and written) that facilitate therapeutic relationships between patients, family, and health care providers
Intermediate computer skills with the ability to become proficient in the Electronic Health Record (EHR) with on-the-job training
Excellent attendance, interpersonal skills and work history required.
Facilitates coordination of patient services in assigned patient care unit, or department
Utilization Review Coordinator (Rn), Behavioral Health-Per Diem
By Coast Plaza Hospital At , Norwalk, 90650, Ca
Possesses skill set to provide clerical support to the Case Management Department.
Excellent time management skills with a proven ability to meet deadlines.
Demonstrates knowledge and skill set to process BHU Medical TARS
Regularly attends required in-services and continuously takes an active interest in furthering one's knowledge.
Has the willingness and ability to perform all other duties and responsibilities as assigned
Five years + experience in acute care hospital Utilization Review and RN Required
Utilization Review (Ur) Specialist
By Stonington Institute At , North Stonington, 06359, Ct
Knowledge of UR processes required for all payor sources i.e. precertification, concurrent reviews, discharge review.
Complete initial precertification for all levels of care.
Collaborate with clinicians/case managers to obtain pertinent clinical and discharge information.
Liaison between insurance and clinical staff, providing information to clinicians/case managers regarding dispositions that would be approved by insurance.
Consult with Admissions Department regarding specific LOC issues, insurance requests, and/or criteria questions.
Conduct concurrent reviews on assigned cases.

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