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
Create an Alert for Utilization Review Specialist Jobs
Create a Job Alert
Get notified when new Utilization Review Specialist jobs are posted
COTA. Mary Free Bed Rehabilitation Hospital · 3N Therapy-Spinal Cord InjuryGrand Rapids, MITherapy ServicesFull-Time, Days, 7 : 30am-4 : 00pmReq # 12149. Summary. Provides occupational therapy services as assigned by, and under the supervision of, an occupational therapist. Keeps treatment skills updated through continuing education, evidence-based research, and program development. Perform job responsibilities in accordance with the program’s st...
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 ...
Overview. Sycamore Springs. Fully In-Person Role. Utilization Review Specialist. Full Time, Monday-Friday. . . Members of our team Enjoy. . Working with a highly engaged staff. Healthy staffing levels. Flexible scheduling. Career growth. Competitive compensation. Health, Vision, Dental, 401k, and Paid Time Off. UKG Wallet – We’ve partnered with UKG Wallet, a voluntary Earned Wage Access benefit, to offer employees access to their pay on their own...
Overview. Sycamore Springs. Fully In-Person Role. Utilization Review Specialist. Full Time, Monday-Friday. . . Members of our team Enjoy. . Working with a highly engaged staff. Healthy staffing levels. Flexible scheduling. Career growth. Competitive compensation. Health, Vision, Dental, 401k, and Paid Time Off. UKG Wallet – We’ve partnered with UKG Wallet, a voluntary Earned Wage Access benefit, to offer employees access to their pay on their own...
Under limited direction and in accordance with established policies, procedures, guidelines and criteria, regularly exercises clinical judgment in the review and assessment of patients' records. Reviews care and treatment received. Communicates with third party payers in order to obtain authorization for care. Acts as a resource to related parties by providing training and educational sessions. EDUCATION AND EXPERIENCE. Associate's Degree in Nurs...
Responsibilities. Are you caring, compassionate and hardworking. Our facility can provide a place for you to thrive and continue your professional development. Stonington Institute, a division of one of the nation’s largest and most respected hospital companies, Universal Health Services, Inc. UHS), has an immediate opening for a full-time UR Specialist. Stonington Institute is committed to providing quality substance abuse treatment options for ...
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...
Job Summary. Performs utilization review with external agencies to ensure payment for medically necessary inpatient services. Essential Functions. Consistently uses an outward mindset and puts forth exemplary effort in accomplishing his / her goals and objectives in a manner that helps others to achieve their goals and objectives. Performs ongoing review of charts for inpatient psychiatric patients and partial hospitalization patients based on ap...
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...
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 outstanding patient care. Join a team where everyone knows each other and works together towards our mission to provi...
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...
Are you prepared for the impact you can make in your career at a well-respected treatment center in Brooksville, Florida. If so, you may enjoy working at Sabal Palms Recovery Center, an addiction treatment facility nestled on a 10-acre campus located along Florida's Nature Coast and surrounded by live oak trees. Sabal Palms Recovery Center provides premier residential treatment for adults age 18 and older who are struggling with addictions. Our s...
