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Utilization Review Specialist Jobs

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
Behavioral Health Utilization Review Specialist
By County of Santa Cruz At ,
Invites you to apply for:
BEHAVIORAL HEALTH UTILIZATION REVIEW SPECIALIST
To view full job announcement:
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 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 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
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.
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%)
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
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.
Utilization Review Specialist - Behavioral Health
By Prestige Utilization Management & Billing Solutions At , Remote $35,000 - $40,000 a year
Excellent data entry skills and ability to navigate electronic systems applicable to job functions
Ensure all pre-certifications are completed for inpatient and outpatient services
Work with facilities to ensure documentation requirements are met
Interface with managed care organizations, external reviews, and other payers
2 or more years experience billing UR healthcare industry – in the mental health/addiction field.
Working knowledge of clinical case formulation for substance abuse/mental health treatment.
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 Business Support Specialist
By Allegheny Health Network At , , Pa
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%)
Utilization Review Specialist - Behavioral Health
By WellBridge Fort Worth At , Fort Worth, 76132, Tx
Coordinate utilization management reviews for all assigned inpatient, partial hospitalization and intensive outpatient program patients.
Coordinates closely with Director of Utilization Management, Nursing and Clinical Services.
Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies.
Obtains authorizations for services, coordinates peer-to-peer reviews for assigned caseload.
Understands medical necessity criteria and facilitates accurate and timely documentation to support advocacy of services.
Master’s Degree in Social Work, Marriage and Family Therapy or Counseling from an accredited school or BSN, RN

Are you looking for an exciting opportunity to use your clinical and administrative skills to help ensure quality patient care? We are looking for a Utilization Review Specialist to join our team and help us provide the best care possible. As a Utilization Review Specialist, you will be responsible for reviewing and analyzing patient medical records to ensure that services are medically necessary and meet the standards of care. You will also be responsible for providing guidance and support to providers and staff to ensure compliance with regulatory requirements. If you are looking for a challenging and rewarding position, this is the job for you!

Overview:

A Utilization Review Specialist is responsible for ensuring that health care services are provided in an efficient and cost-effective manner. They review medical records and other documentation to determine the appropriateness of services provided and to ensure that services are in compliance with applicable regulations. Utilization Review Specialists also provide guidance to health care providers on the most cost-effective and appropriate treatments for their patients.

Detailed Job Description:

Utilization Review Specialists are responsible for reviewing medical records and other documentation to ensure that health care services are provided in an efficient and cost-effective manner. They evaluate the appropriateness of services provided and ensure that services are in compliance with applicable regulations. Utilization Review Specialists also provide guidance to health care providers on the most cost-effective and appropriate treatments for their patients. They may also be responsible for developing and implementing utilization review plans, policies, and procedures.

What is Utilization Review Specialist Job Skills Required?

• Knowledge of medical terminology and coding
• Knowledge of health care regulations and standards
• Ability to analyze medical records and other documentation
• Ability to interpret and apply regulations and standards
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Strong organizational and problem-solving skills
• Computer proficiency

What is Utilization Review Specialist Job Qualifications?

• Bachelor’s degree in health care administration, health information management, or a related field
• Certification in utilization review (preferred)
• At least two years of experience in utilization review or a related field

What is Utilization Review Specialist Job Knowledge?

• Knowledge of medical terminology and coding
• Knowledge of health care regulations and standards
• Knowledge of utilization review plans, policies, and procedures

What is Utilization Review Specialist Job Experience?

• At least two years of experience in utilization review or a related field

What is Utilization Review Specialist Job Responsibilities?

• Review medical records and other documentation to ensure that services are provided in an efficient and cost-effective manner
• Evaluate the appropriateness of services provided and ensure that services are in compliance with applicable regulations
• Provide guidance to health care providers on the most cost-effective and appropriate treatments for their patients
• Develop and implement utilization review plans, policies, and procedures
• Monitor utilization review activities to ensure compliance with applicable regulations
• Maintain accurate records of utilization review activities