The Utilization Review Specialist monitors patient charts and records to evaluate care concurrent with the patients treatment. Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Being a Utilization Review Specialist collects and complies data as required and according to applicable policies and regulations. Reviews treatment plans and status of approvals from insurers. In addition, Utilization Review Specialist consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Reg ...istered Nurse(RN). Being a Utilization Review Specialist contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. Working as a Utilization Review Specialist typically requires 4 to 7 years of related experience.More Show Less
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Overview. Advanced Recovery Systems. is an integrated behavioral healthcare management company dedicated to the treatment of addiction, substance abuse, and mental health issues. We put behavioral health front and center, providing assistance to people with substance abuse issues, addictions and mental health concerns. At Advanced Recovery Systems, we are committed to the journey of long-term recovery for our patients. As a Utilization Review Spe...
Location. Brooklyn, NY 11235. Duration. 13 weeks of contract (extendable). Shift. 08 hrs / day & 40 hrs. / week ( 8 : 30 AM-4 : 30 PM). Hourly pay. $65 / hourly. Education. Foreign Medical Graduate (FMG). Bachelor's Degree. Skills. EMR. Duties. Use clinical knowledge to review medical charts for accuracy and sequencing of diagnosis to those assigned from Consultation reports, History and Physical reports, Operative reports, Progress reports. Disc...
Job Details. Job Location. Henderson - 1711 Whitney Mesa - Henderson, NV. Position Type. Full Time. Education Level. 2 Year Degree. Salary Range. $45,000.00 - $45,000.00 Salary. Job Shift. Any. Description. Position Summary. Person in this position is responsible for collecting clinical information and communicating with MCOs in a timely manner in order to advocate for the highest level of care that is supported by the clients acuity, and in comp...
Description. Shodair is looking to hire a new Utilization Review Specialist. Utilization Review primarily focuses on evaluating and managing the utilization of healthcare services, treatments, and procedures. It aims to ensure that the services provided are medically necessary, cost-effective, and aligned with established guidelines. The Ideal Candidate Is Someone Who. Maintains knowledge of insurance plans requiring pre-authorizations and referr...
Location: WK Medical Center. Department: Care Management. Classification: Full-Time. Shift: 7:30 AM-4:00 AM. Date Posted: 5/23/2024. Description. UTILIZATION REVIEW POSITION. Centralized staff located at Innovation Center in Bossier. Licensed (RN, LPN, MA) Positions Available. The primary responsibility of Utilization Review is to review medical records and prepare clinical appeals (when appropriate) on medical necessity, level of care, length of...
Essential Functions. Act as liaison between managed care organizations and the facility professional clinical staff. Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements. Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay. G...
Overview. We are seeking a dedicated Utilization Review Specialist to join our healthcare team. The ideal candidate will be responsible for reviewing medical records and ensuring that patients receive appropriate care based on medical necessity and established guidelines. Duties. Conduct utilization reviews and level of care certifications for PHP and IOP patients. Evaluate clinical information to ensure medical necessity and compliance with insu...
Job Summary. Performs admission and concurrent stay medical record review to determine appropriateness of admission, continued stay, and setting. Follows patient throughout hospitalization collaborating with attending physician and other health care providers. Communicates with third party payors to obtain authorization. Contributes to appropriate throughput and length of stay. Assists with denial management. Reviews physician medical record docu...
Overview. We are seeking a dedicated Utilization Review specialist to join our Substance Abuse Treatment Facility. The ideal candidate will play a crucial role in evaluating the medical necessity, appropriateness, and efficiency of services for our clients. This role will be expected to work closely with Northstar's clinical team to best serve clients' needs. Duties. Conduct utilization reviews to ensure medical services meet quality standards an...
The Utilization Review Coordinator utilizes the nursing process with individual patients and groups of patients to assist them in meeting their physiological, psychological, safety, and general health needs. Review all patients’ admissions on a daily basis to determine necessity and appropriateness of placement services as outlined in Plans and Procedures. Assigns continued stay reviews according to criteria. reviews continued stay at least every...
Responsibilities. JOB SUMMARY. Responsible to ensure that open charts are reviewed appropriately to identify the utilization of services. The information collected by the Utilization Review Specialist will be used to contact insurance/review companies to obtain certification for the hospital stay. . Qualifications. JOB SPECIFICATIONS. To perform this job successfully, an individual must be able to demonstrate competency in the criteria listed in...
Responsibilities. JOB SUMMARY. Responsible to ensure that open charts are reviewed appropriately to identify the utilization of services. The information collected by the Utilization Review Specialist will be used to contact insurance / review companies to obtain certification for the hospital stay. Qualifications. JOB SPECIFICATIONS. To perform this job successfully, an individual must be able to demonstrate competency in the criteria listed in ...
