Healthcare Utilization Review Specialist
$20 - $30 per hourGuidelight Health
A behavioral healthcare organization is seeking a Utilization Review Specialist to conduct clinical auditing and negotiate authorizations. The ideal candidate has a Bachelor's degree in Social Work or Nursing and 1-2 years of healthcare experience. Responsibilities include conducting live reviews, coordinating with clinical teams, and ensuring compliance with regulations. The position offers a pay range of $20 - $30 USD, along with comprehensive benefits including medical, dental, and professional development opportunities. #J-18808-Ljbffr
- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure... ...two years in utilization review or related fields, and proficiency with Microsoft Office and healthcare software. #J-18808-LjbffrSuggestedWork at officeRemote work
- To support the treatment of addiction and mental health issues, the full-time Remote Utilization Review Specialist will manage pre-authorizations and concurrent reviews, collaborating with case managers and the multidisciplinary treatment team to ensure compliance with...SuggestedFull timeRemote work
- Recovery Unplugged is seeking an experienced Utilization Review Specialist to join our team. This remote, part-time role focuses on obtaining and maintaining insurance authorizations, communicating with managed care organizations, and collaborating with clinical teams....SuggestedRemote jobPart timeWeekend work
- Managing insurance authorizations for mental health and substance use treatment, the full-time Behavioral Health Utilization Review Specialist will verify benefits, complete prior authorizations, and support medical necessity criteria while working remotely. Key responsibilities...SuggestedFull timeRemote work
- Cohere Health seeks an experienced RN Reviewer to perform prospective, concurrent, and retrospective reviews ensuring medical necessity and high-quality care. You will collaborate with Medical Directors, providers, and cross-functional teams to apply MCG and Cohere guidelines...SuggestedRemote jobFlexible hours
- ...Sanford Health, the largest rural health system in the United States, seeks a registered nurse to perform utilization management, medical necessity reviews, and prior authorization coordination. The role supports compliant, cost-conscious care across our large network....
$23.1 per hour
...We are currently seeking a Health Care Specialist (HCS) to work full-time at our Bay Ridge... ...direct care staff. Conducts timely reviews of anecdotals and presents questions to... ...Basic computer skills – including email, utilizing Workday and related systems (DA, etc.) to...Full time$32.85 - $35.71 per hour
Broadcast Standards & Practices Associate / Ad Review Specialist 2 days ago Be among the first 25 applicants Get AI-powered advice on this... ..., claim support, and other documentation obtained and utilized in the clearance process is an integral part of this role....Fixed term contract$47k - $50k
...housing. Position: Housing Specialist Reports To: Sup II (Clinical... ...such matters as education, healthcare, housing, social services,... ...etc.) and local landlords. Review all approved housing... ...and all payments to landlord/utilities are up-to-date with apartment...Permanent employmentFull timeTemporary workLive inLocal area- ...The CareIQ Intake Specialist provides administrative customer service assistance to... ...receiving and entering new ancillary healthcare referrals. Utilizing proprietary systems and knowledge... ...environment Completes accurate data entry and review Able to learn and operate corporate...Minimum wageFull timeWork experience placementWork at officeLocal areaRemote workMonday to FridayFlexible hours
$18.92 - $23.46 per hour
...Recognized as a “Best Place to Work Modern Healthcare” – Join a team where people come first.... ...matters. Proven knowledge and skill in utilizing MS Office suite of software and pharmacy... ...Meridian, MS. Duties/Responsibilities Review patient files for completeness and accuracy...Full timeContract workTemporary workLocal areaImmediate startFlexible hours$18.99 - $23.37 per hour
...Revenue Cycle Specialist The Revenue Cycle Specialist is responsible... ...Athenahealth worklists, reviewing patient accounts and determining... ...reconcile payment activity utilizing bank portals, payer portals,... ...(1) year of experience in healthcare revenue cycle, medical...Work at officeLocal areaRemote work$17.84 - $28.02 per hour
...properly in the contractual timeline. Supports utilization management team to document... ...documentation for services related to the members healthcare eligibility and access. Key Details:... ...and guidelines Supports the authorization review process by researching and documenting...Hourly payFull timePart timeH1bWork at officeRemote workFlexible hours- ...provides the highest quality healthcare services to residents of... ...000 primary care providers, specialists and participating clinics. For... ...worker is unavailable. Utilize the personal lived experience... ...Treatment/Recovery Plans will be reviewed and signed by Team Leader...Work at officeLocal areaTrial period
- ...or insurance authorizations as required. Review status of waiting room on a routine... ...experience in a medical office setting, utilizing a computer system for physician scheduling... ...innovation as we work together to transform healthcare. We encourage all team members to...Hourly payTraineeshipWork at officeLocal area
$52k - $65k
...leading-edge SaaS company in healthcare, we deliver solutions that help... ...Job Overview The Deal Desk Specialist I executes quote building, contract... ...Responsibilities And Duties Review and process incoming deal... ...the hiring process. We utilize advanced screening methods to...Remote jobContract work$17 - $21 per hour
Health Information Specialist I 7823 New York, NY 10029 Full-time regular... ...platform trusted for healthcare. Guided by our mission to make... ...to CDs, storage ordering/reviewing . This is a patient-facing role... ...proficiency. Comfortable utilizing phones, fax machines, printers...Hourly payFull timeFor contractorsWork experience placementWork at officeMonday to Friday$93.8k - $156.3k
...touches virtually every aspect of healthcare. We are known for delivering... ...from you. Title: Sr. Legal Specialist - Provider Solutions... ...approaches where appropriate. Review, analyze, and negotiate commercial... ...and related documentation, utilizing approved templates and...Contract workRemote work$80k - $120k
Program Controls Specialist - Utility Field Safety Operations Location : Somerset, NJ Job Type : Full-time Schedule : Monday through Friday... ..., training, badging, and access-readiness status Review labor-hour trends, staffing utilization, overtime, inactive...Full timeFor contractorsLocal areaMonday to FridayShift work- iMPROve Health is seeking an Independent Review Specialist to support IDR/IIDR case reviews on a contingent basis. The role requires... ...varied case volumes and deadlines. Ideal candidates will have healthcare utilization review or case management experience and strong...Remote jobFlexible hours
- Remote Enrollment Specialist (Certified Medical Assistant) Remote in... ...looking to continue in healthcare from a remote position while... ...patients understand the value of utilizing our CCM and RPM programs.... ...Friday Our Process We will review your application along with...Remote jobWork at officeMonday to Friday
$40 - $50 per hour
...Summers , and Jack Dorsey . Position: Healthcare Administrative Specialist Type: Contract Compensation: $40–$... ...efficient processes for prior authorizations and utilization support through payer portals. Review and manage claims and revenue cycle...Contract workSummer workWork at officeRemote work- A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote... ...experience in clinical practice and knowledge of Utilization Review Guidelines. The position offers a...Remote work
- ...About Amperos Amperos is healthcare's first AI-native denial management and revenue recovery... ...for a Senior Accounts Receivable Specialist to join our client onboarding team — a small... ...detail to act on immediately Conduct QA reviews of permanent BA work during the...Permanent employmentFull timeWork at officeImmediate startFlexible hours
- ...CitiMed is a unique medical facility that provides exclusive healthcare amenities to our community. The range of medical and rehabilitative... ...of professionalism in all communications and interactions. Review reports and ensure accurate record-keeping within electronic...Full time
$42 per hour
...Medicare Annual Wellness Visit Specialist - PRN Full-time WHO IS... ...powered, performance-driven healthcare company dedicated to operational... ...are completed. Virtually reviewing and updating patient medical... ...factors for chronic diseases, utilizing remote monitoring tools when...Bi-weekly payFull timeTemporary workFor contractorsReliefLocal areaRemote workWork from homeMonday to Friday- UnitedHealth Group seeks a licensed psychologist (Ph.D. or Psy.D.) in Florida to serve as a Peer Reviewer for outpatient and ABA cases, applying clinical and benefit criteria to determine coverage. Primary duties include clinical reviews, authorizations, appeals, and participating...Remote job
- ...workplace, and mixed-use to civic, education, healthcare, and residential. Its teams bring... ...confidence. THE OPPORTUNITY The BIM Specialist will help project teams across the firm'... ...Run clash detection, lead coordination reviews with internal teams and consultants, and...
$24 per hour
...Job Description Job Description Pride Health is hiring a Peer Specialist to support our client's healthcare facility in Brooklyn, NY. The Peer will utilize experience as a recipient of behavioral health services with a willingness to share personal, practical experience...Contract workTemporary workLocal areaFlexible hoursNight shiftAfternoon shift- ...HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven... ...in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers...Private practiceWork at officeImmediate startRemote work
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