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Utilization Review Manager Jobs

Administrative Review Manager Jobs
By DMR-Metro Region At , Waltham $70,002 - $107,609 a year
Monitor the Incident Management system in the Home and Community Service Information System (HCSIS) for accurate and timely data entry.
In-depth knowledge of DDS management hierarchy and functionality, optimizing navigation within the organization.
Proficiency in data management and Microsoft Excel.
Education, licensure, and certifications will be verified in accordance with the Human Resources Division's Hiring Guidelines.
Five (5) years of human services experience, demonstrating practical expertise and a comprehensive understanding of the field.
Proven highly effective organizational skills.
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 ...

Alm Review Manager Jobs
By U.S. Bank National Association At , $125,715 - $162,690 a year
5 plus years of experience in financial risk management
Considerable knowledge of applicable laws, regulations, financial services, and regulatory trends related to liquidity risk or interest rate risk management
Strong process facilitation, project management, and analytical skills
Partners with Corporate Treasury and second line risk management to promote an effective risk management framework.
Bachelor's degree, or equivalent work experience
Typically more than 10 years of applicable experience
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 Nurse-Weekends Jobs
By Sentara Healthcare At , Virginia Beach, 23462
Must possess 2-3 years of acute care clinical experience.
Previous Utilization Review experience a plus.
InterQual or Milliman experience preferred.
This position is Remote, Weekend Days.
Bachelor’s Degree in Nursing preferred
Basic Life Support (BLS) - Other/National
Utilization Review Nurse - Outpatient
By Johns Hopkins University At , Baltimore, 21218

Requisition #: 627353 Location: Johns Hopkins Health Plans, Hanover, MD 21076 Category: Nursing Schedule: Day Shift Who you are: As a Utilization Review Registered Nurse for Johns ...

Utilization Review Nurse Jobs
By Samaritan Health Services At , Corvallis $40.88 - $60.03 an hour
Acute care utilization review, discharge planning or case management experience preferred.
Utilization Review or Case Management Certification preferred.
Experience and/or training in insurance benefits or covered services including Medicare and Medicaid required.
Three (3) years RN experience required.
Experience and/or training in computer applications required. Typing speed of 35 wpm preferred.
Three (3) years hospital nursing experience preferred.
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 Nurse Jobs
By Mercy At , Springfield, 65804
Education: Graduate of an accredited school of nursing.
Experience: 2-3 years acute care hospital setting.
Tuition Reimbursement up to $2,000 for continuing education
Licensure: Current license in the state of residence and/or employment.
Health/Dental/Vision available after day one
Annual contribution of $100 per month to eligible co-workers enrolled in the Dependent Care FSA
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 Manager - Intake Team
By Ascension At , Austin, 78736 From $72,758 a year
3 years of leadership or management experience preferred.
2+ years health plan Utilization Management health plan experience
2+ years of management / leadership experience (with direct reports)
Department: Ascension Care Management Insurance
Manage all activities related to staffing, including hiring, training, orienting, evaluating, disciplinary actions and continuing education initiatives.
Experience working in a fast paced Call Center environment
Utilization Review Nurse - Outpatient
By Johns Hopkins Health Plans At , Hanover
Excellent verbal/written communication skills to effectively interact and work collectively with enrollees, physicians, facility staff and management staff
Understanding of managed care delivery systems and utilization management
1+ years’ experience in Managed Care/Utilization Review is required
Knowledge and expertise in utilizing various criteria sets (i.e. InterQual)
3+ years’ experience as an acute care RN
This position is eligible for remote work.
Utilization Review Clinical Specialist (Remote)
By CHS Corporate At , Franklin, 37067

Computer Skills Required: Data entry skills; Demonstrable skills with Google Docs, Google Sheets, and email applications.

Utilization Review Nurse Selecthealth
By Intermountain Healthcare At , Murray $38.83 - $57.46 an hour

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

Anticipated job posting close date:

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 Nurse Jobs
By MEDSTAR HEALTH At , Washington, 20010
Associate degree in Nursing with five years of bedside nursing experience can be used in lieu of the Bachelor's degree requirement.
Prior experience as a Case Manager required
Knowledge of reimbursement models (commercial, managed care, Medicare) is preferred.
Prior experience in a hospital or office type setting preferred
Prior utilization review experience preferred
Knowledge of MS Office Suite

Are you looking for a challenging and rewarding role in healthcare? We are seeking an experienced Utilization Review Manager to join our team! You will be responsible for managing the utilization review process, ensuring that all services are medically necessary and appropriate. You will also be responsible for developing and implementing policies and procedures to ensure compliance with applicable regulations. If you have a passion for healthcare and are looking for an opportunity to make a difference, this is the job for you!

A Utilization Review Manager is responsible for overseeing the utilization review process for a healthcare organization. This includes ensuring that all utilization review activities are conducted in accordance with applicable laws and regulations, as well as the organization’s policies and procedures.

What is Utilization Review Manager Skills Required?

• Knowledge of utilization review processes and procedures
• Knowledge of healthcare regulations and laws
• Excellent communication and interpersonal skills
• Ability to analyze data and make decisions
• Ability to work independently and as part of a team
• Ability to manage multiple projects and prioritize tasks
• Proficiency in Microsoft Office Suite

What is Utilization Review Manager Qualifications?

• Bachelor’s degree in healthcare administration, business administration, or related field
• At least 5 years of experience in utilization review
• Certification in utilization review (preferred)

What is Utilization Review Manager Knowledge?

• Knowledge of healthcare reimbursement and coding
• Knowledge of medical terminology
• Knowledge of healthcare quality assurance and improvement
• Knowledge of healthcare data analysis

What is Utilization Review Manager Experience?

• Experience in utilization review management
• Experience in healthcare administration
• Experience in healthcare quality assurance and improvement

What is Utilization Review Manager Responsibilities?

• Develop and implement utilization review policies and procedures
• Monitor utilization review activities to ensure compliance with applicable laws and regulations
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