3 Utilization Review Specialist Jobs in Greenville, NC
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ECU Health is Hiring an Utilization Review Specialist Near Greenville, NC
Position SummaryThe Utilization Review Specialist will ensure regulatory compliance with CMS Conditions of Participation with regard to Utilization Management. Perform Utiliztion Review according to CMS and commercial payor guidelines. Participate in denial / appeal process.
Responsibilities
- Utilization Management. Utilizes the nursing process to assess, plan, implement and evaluate the utilization management needs for patients in assigned caseload.
- Performs utilization management activities using approved screening criteria.
- Clinical Progression and Utilization Management. Participates in quality improvement (QI) activities.
- Advances knowledge and skills in case / utilization management.
- Collaborates effectively with departmental staff to achieve goals and objectives.
- Associates Degree in Nursing required; BSN preferred.
- NC RN licensure required.
- If ADN prepared must have 5 years experience in an acute care hospital; home health agency; commercial insurance company; case management.
- If BSN prepared must have 3-5 years experience in an acute care hospital; home health agency; commercial insurance company; case management.
- A certification in Case Management (i.e. CCM, ACM) can substitute for 1 year of experience; Masters Degree in health related field can substitute for 1 year of experience.
General StatementIt is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.
Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.
We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.
Job Summary
Full Time
$62k-87k (estimate)
05/15/2023
08/11/2024
The job skills required for Utilization Review Specialist include Utilization Management, Case Management, Acute Care, Quality Improvement, etc. Having related job skills and expertise will give you an advantage when applying to be an Utilization Review Specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Utilization Review Specialist. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Utilization Review Specialist positions, which can be used as a reference in future career path planning. As an Utilization Review Specialist, it can be promoted into senior positions as an Utilization Review Manager - Home Care that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Utilization Review Specialist. You can explore the career advancement for an Utilization Review Specialist below and select your interested title to get hiring information.
If you are interested in becoming an Utilization Review Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become an Utilization Review Specialist for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Utilization Review Specialist job description and responsibilities
Utilization Review Specialists ensure that Doctors and Nurses choose only the best treatments for them.
03/11/2022: Fort Myers, FL
Utilization review typically refers to the review of services that have already been delivered, while utilization management often refers to the review of coverage for future medical services.
02/16/2022: Louisville, KY
Assess plans for patient care and determine what treatment is appropriate and most cost-effective
02/15/2022: Augusta, GA
Analyze electronic medical records, and inform medical staff whether a medical claim is denied,
03/11/2022: Boston, MA
Prepares and submits regular reports on utilization control and on review activities.
02/26/2022: Reading, PA
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Utilization Review Specialist jobs
Know where to find utilization review jobs.
03/13/2022: Clarksville, TN
Create a utilization review cover letter.
02/18/2022: Reno, NV
Sign up for free credit monitoring.
03/16/2022: New London, CT
Set up documentation shortcuts.
03/05/2022: Lawton, OK
Take the certification examination.
05/08/2022: New Bedford, MA
Step 3: View the best colleges and universities for Utilization Review Specialist.
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