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Utilization Review Manager Jobs in Brinkhaven, Knox, 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 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
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.
Utilization Review Nurse Jobs
By Nascentia Health At , Syracuse, 13204, Ny
Three or more years of utilization management or quality improvement experience preferred.
Professional competencies, skills and abilities:
Creates and facilitates educational programs.
Identifies and collaborates with UR Manager on individual cases
Identifies and collaborates with UR Manager on trends in usage patterns.
Five or more years of home health care or long term care experience strongly preferred.
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.
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.
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.
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
Rn Specialist Utilization Review
By HonorHealth At , Scottsdale, 85258
Determines qualifications for hospital level of care based on set criteria.
Initiates chart reviews, conducts follow-up reviews, and escalates secondary reviews to Physician Advisor as necessary.
Performs other duties as assigned.

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
•