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
- ...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
- ...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
$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- ...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
- ...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
$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
- ...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
- ...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
$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$18.92 - $23.46 per hour
Recognized as a “Best Place to Work Modern Healthcare” - Join a team where people come first.... ...is 100% remote. Duties/Responsibilities Review patient files for completeness and... ...documentation. Proven knowledge and skill in utilizing the MS Office suite of software and...Full timeContract workTemporary workLocal areaImmediate startRemote workFlexible hours$50k - $60k
...with established controls. Manage bonus review and approval processes, track exceptions... ...at Company locations Demonstrate and utilize active listening, inductive reasoning, information... ...for transportation, skilled trades and healthcare/dental. Across our two brands, Universal...Local areaImmediate startRemote workFlexible hours- ...OCA’s Policy and Training Division, within which the CAN Case Review Specialist position is housed, furthers OCA’s goals to: Provide a voice... ...CAN Panel from the Office of the Investigation Coordinator. Utilize OCA’s data management system to enter and track cases...Full timeWork at office
$18.99 - $23.37 per hour
...Description The Revenue Cycle Specialist is responsible for... ...assigned Athenahealth worklists, reviewing patient accounts and determining... ...reconcile payment activity utilizing bank portals, payer portals,... ...one (1) year of experience in healthcare revenue cycle, medical...Work at officeLocal areaRemote work$55k - $68k
...medication management. We improve healthcare workflows and help patients... ...The Workforce Management Specialist owns capacity planning,... ...for leadership operational reviews. Scheduling and Real Time Management... ...shrinkage, occupancy, and utilization trends and recommend...Temporary workSeasonal workImmediate startRemote workFlexible hours$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... ...needed. Assist with payer audits and utilization management reviews by providing complete...Hourly payRemote work$21 - $22 per hour
...Vision is to revolutionize healthcare by pioneering innovative solutions... ...Position: Guest Eligibility Specialist I Job Type: Full-Time / Non-... ...entered into the system. By reviewing clinical documentation per... ...to insurance companies and utilize payer portals to follow on...Hourly payPermanent employmentFull timeTemporary workWork at officeRemote workMonday to FridayShift work$21.05 per hour
We are currently seeking a Health Care Specialist (HCS) to work full-time in our Brooklyn Supportive... ...to direct care staff. Conducts timely reviews of anecdotals and presents questions to... ...computer skills - including email, utilizing Workday and related systems (DA, etc.)...Full timeMonday to Friday- ...Behavioral Health Technicians Pyramid Healthcare is dedicated to offering the... ...seeking a Certified Recovery Specialist (CRS) to support individuals... ...Use Disorder (OUD) . The CRS utilizes lived experience, recovery-... ...Assist in the development, review, and ongoing updating of...Work experience placementMonday to Friday
$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
- ...of the Precertification Team Manager, the Utilization Management (UM) Specialist is responsible for managing daily non-clinical review activities that support the clinical,... ...works closely with internal departments, healthcare providers, hospitals, and provider office...Work experience placementWork at officeLocal areaRemote work
- ...themselves to making a difference in the healthcare industry, and in people's lives.... ...) Job Summary: The Charge Capture Specialist II is responsible for reviewing clinical documentation to ensure... ...equipment and machinery and utilizes ergonomic workstations, equipment,...Work at officeShift 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
$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
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