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. 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...
Description. Odyssey House is looking for a Full-Time Utilization Review Specialist. Summary. Odyssey House's Mission is "Empowering people to heal and build better lives. We are dedicated to helping individuals and families reclaim their lives through effective substance use treatment, medical care, prevention, and mental health services. Odyssey House continues to receive Best of State awards for our clinical work and has received Top Workplace...
SIGN-ON BONUS. $5,000 - if Licensed Registered Nurse (RN). 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 an...
Employment Type: Full-Time. 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 ...
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...
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...
Job Details. Job Location. Parkside Hospital - Tulsa, OK. Salary Range. Undisclosed. Utilization Review Specialist. Do you enjoy making a difference in a patient’s life. Do you want to make a difference in your community. Come work at Parkside. . Where healing happens. Every day. Parkside is a 120 bed, private, non-profit psychiatric hospital, and provides outpatient services as well. Each department works together day in and day out to provide o...
Job Details. Job Location. Parkside Hospital - Tulsa, OK. Salary Range. Undisclosed. Utilization Review Specialist. Do you enjoy making a difference in a patient’s life. Do you want to make a difference in your community. Come work at Parkside. . Where healing happens. Every day. Parkside is a 120 bed, private, non-profit psychiatric hospital, and provides outpatient services as well. Each department works together day in and day out to provide o...
Job Details. Job Location. Parkside Hospital - Tulsa, OK. Salary Range. Undisclosed. Utilization Review Specialist. Do you enjoy making a difference in a patient’s life. Do you want to make a difference in your community. Come work at Parkside. . Where healing happens. Every day. Parkside is a 120 bed, private, non-profit psychiatric hospital, and provides outpatient services as well. Each department works together day in and day out to provide o...
Quadrant Billing Solutions is looking to add to our growing medical billing company. We specialize in the substance abuse/mental health industry. The position we are looking to fill is Utilization Review Specialist with 3 years clinical experience. We are looking for highly motivated, eager individuals that are looking for an opportunity to learn and grow with the company. Here are some of the requirements we are looking for. Ability to be aggres...
