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
- ...is a nationally recognized behavioral healthcare institution that delivers quality, medically... ...For We are seeking an experienced specialist who is passionate about making a... ...field required preferred. 2-3 years of utilization review experience in behavioral health, addiction...SuggestedDaily paidFull timeRemote work
- ...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
- ...Gosnold is seeking an Utilization Review Specialist to perform pre-certification and concurrent reviews, working closely with clinical teams to coordinate care and ensure patient coverage. The role requires strong communication with Patient Financial Services and meticulous...Suggested
- ...The Arizona Health Care Cost Containment System (AHCCCS) is seeking a Behavioral Health Prior Authorization Utilization Review Consultant. The role focuses on monitoring, evaluating, and approving or denying payment for medical and behavioral health services for the Fee...SuggestedRemote work
- ...FHE Health in the United States seeks an experienced Utilization Review Specialist to manage clinical authorization processes, ensuring timely, accurate, and compliant communications with insurance payers. You will support patient access by securing initial and continued...SuggestedRemote work
$69.39k - $88.61k
...Cincinnati Children’s is seeking an experienced Utilization Review professional for a remote role in the United States. The position supports case management, authorization, compliance, and education within the Utilization Review department. The role requires a Bachelor...Full timeRemote work- ...WNS HealthHelp (A Capgemini Company) is seeking a licensed registered nurse to perform concurrent inpatient utilization reviews from a remote setting. You will collaborate with attending physicians and care teams to determine medical necessity and appropriate level of...Remote work
- ...Community Memorial Hospital, Inc. is seeking an experienced RN to lead utilization review activities at our Hamilton, NY facility. You will conduct concurrent, retrospective, and pre-admission reviews to determine medical necessity and level of care. Work with physicians...
- ...Odyssey House is looking for a Full-Time Utilization Review Specialist. Summary: Odyssey House's Mission is "Empowering people to heal and build... ...received Top Workplace Awards. Join our amazing team of healthcare professionals today!" Full-Time Benefits: $9k per year tuition...Full timeContract workTemporary workCasual workLocal areaImmediate startFlexible hoursShift work
- The Utilization Review Specialist's primary role is the liaison between the hospitals inpatient and ambulatory services and the managed care organizations... ..., Benefits and Patient Accounts. One year experience in Healthcare and/or Managed Care Setting required. Undergraduate/...
- Spectrum Billing Solutions is seeking an ABA Utilization Review Specialist to review clinical data and obtain authorized services for ABA and related treatments. This role offers either remote work or a home-office hybrid setup, with collaboration across clinical staff...Remote jobWork from homeHome office
$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- CVS Health is seeking a Registered Nurse (RN) for Utilization Management to ensure appropriate care delivery and coordinate patient care with clinical teams. The role emphasizes evidence-based review, care coordination, and collaboration with providers to optimize outcomes...Remote jobFull timeFlexible hoursAfternoon shift
- ...advanced care to our neighbors throughout the region. Organization Utilization Management Job Summary Facilitates optimal reimbursement... ...is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary review...Remote jobTemporary workWork experience placementLive outFlexible hours
- ...Imagine360 is currently seeking an Appeals Review Specialist to join our team! The Appeals Review... ...fraud and abuse. Escalates claims to Utilization Management Vendor when appropriate.... ...equivalent Minimum of two years experience in healthcare claims examining or related work...Work experience placementWork at officeRemote work
$76k - $199.6k
...maintain customer engagement by successfully utilizing existing and ever-changing digital tools... ...and/or Account Management Relevant Healthcare/Scientific roles (e.g., RN, Pharmacist,... ...public disclosure. Subject to further legal review and statutory or regulatory...Permanent employmentFull timeH1bLocal areaRemote workVisa sponsorshipWork visaRelocation package- ...Summary: The Utilization Specialist will support Preventive Measures’ Georgia behavioral health operations through authorization management and... ...authorization requests through applicable payer portals and systems. Review authorization packets to ensure all required documentation...For contractors
$76k - $199.6k
..., including Therapeutic Area Specialists, and Key Opinion Leaders (KOLs... ...and in-person settings; utilize a systematic approach to virtual... ...Account Management Relevant Healthcare/Scientific roles (e.g., RN, Pharmacist... .... Subject to further legal review and statutory or regulatory...Permanent employmentFull timeLive inH1bLocal areaRemote workVisa sponsorshipWork visaRelocation package$49.6k - $74.41k
...the Job Welcome to Ovation Healthcare! At Ovation Healthcare (formerly... ...skilled subject matter specialists and operations executives, in... ...guidelines and regulations. Utilizes DDE, CWF, and other tools to... ...with Medicare or patients. Review patient accounts and reconcile...Hourly payFull timeTemporary workWork experience placementWork at officeLocal areaRemote workWork from homeFlexible hours$104.8k - $144.1k
...we improve lives by helping healthcare professionals do their best... ...Post-acute Advanced Wound Care Specialist , you will have the... ...and maintain sales call data utilizing Salesforce.com Identify and... ...motor vehicle record (MVR) review andmaintainongoing eligibility...H1bWork at officeRelocation packageFlexible hoursNight shift- ...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 hoursShift work
$126.4k - $173.8k
...As an Infection Prevention Specialist, Peri-op, you will have the... ...and maintain sales call data utilizing Salesforce.com Identify and... ...motor vehicle record (MVR) review and maintain ongoing eligibility... ...may be required to enter healthcare or other third‑party facilities...Contract workH1bLocal areaRemote workRelocation packageFlexible hoursNight shift$21.05 per hour
...We are currently seeking a Health Care Specialist (HCS) to work full-time in our Brooklyn... ...guidance to direct care staff. Conducts timely reviews of anecdotals and presents questions to... ...computer skills – including email, utilizing Workday and related systems (DA, etc.) to...Full timeMonday to Friday$126.4k - $173.8k
...we improve lives by helping healthcare professionals do their best... ...Description: Infection Prevention Specialist, Peri-op (Solventum) 3M... ...planning, pipeline management, and utilization tracking. Representing... ...motor vehicle record (MVR) review andmaintainongoing eligibility...Contract workH1bWork at officeRemote workRelocation packageFlexible hoursNight shift$26 per hour
...GeBBS Healthcare Solutions is a leading provider of Revenue Cycle Management (RCM) and Risk... ...other payer requirements. Concurrent Reviews and Authorization Management Manage concurrent... ...needed. Assist with payer audits and utilization management reviews by providing...Hourly payRemote work$30 - $41 per hour
...Payor Specialist - LOA, SCA, Third-Party Payors - Healthcare US - Remote The Payor Specialist is responsible for verifying... ...and customer satisfaction by utilizing effective communication and interpersonal... ...to encourage priority review and expedited turnaround times. Interprets...Hourly payWork at officeRemote workHome office$27.11 - $33.83 per hour
DescriptionPosition Title:Leave Unit Specialist-Payroll-Mount Sinai Hospital... ...resolve employee inquiries utilizing knowledge of FMLA/PFL... ...process LOA and PFL payouts;Review 7 consecutive sick days... ...work together to transform healthcare. We encourage all team members...Hourly payFull timeTraineeshipLocal area$85.56k
...scientists equipped to address the healthcare needs of New York’s... ...is currently seeking a Legal Specialist. The successful candidate will... ...filing system for internal review and external production within... ..., reports, and summaries, utilizing such tools as Lexis Nexis Uni...Contract workWork at office$18 per hour
Pyramid Healthcare is dedicated to offering the highest quality of... ...Summary: The Certified Recovery Specialist provides recovery-oriented... ...services. This role utilizes lived experience to assist clients... ...Prepare and complete concurrent reviews and communications with...Work experience placementShift workWeekend work- ...providing solutions that help healthcare organizations provide high... ...challenges. Position: Sourcing Specialist JOB SUMMARY: Ensures the most... ...all purchase orders including, review of purchase orders and... ...affecting healthcare purchasing. Utilizes continuing education opportunities...Temporary workFlexible hours
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Healthcare Utilization Review Specialist. Be the first to apply!
- live chat specialist New York, NY
- patient safety specialist New York, NY
- credit card specialist New York, NY
- senior specialist New York, NY
- zoning specialist New York, NY
- charge entry specialist New York, NY
- health program specialist New York, NY
- youth specialist New York, NY
- microsoft specialist New York, NY
- transportation specialist New York, NY


