Utilization Review Specialist
$69.72kUniversity of Washington
Payer Relations SpecialistUWMEDICINE CONTRACTING & PAYER RELATIONS has an outstanding opportunity for a PAYER RELATIONS SPECIALIST.Work ScheduleFull-Time - 100% FTEHybrid SchedulePosition HighlightsSupport payer relations operations through research, analysis, and coordination of managed care contracting activities.Assist with drafting, reviewing, and maintaining contract documents and credentialing applications to ensure accuracy and compliance.Contribute to negotiations, issue resolution, appeals, and single-case contract development through policy research, document preparation, and stakeholder communication.DescriptionThe PAYER RELATIONS SPECIALIST provides support in the efforts of the Payer Relations Program of the UW Medicine's Contracting & Payer Relations Department in the managed care/health insurance contracting process, including assistance in negotiations of large and small scale managed care agreements, assistance in drafting and review of contract language, maintenance of online and physical contract files, research of payer policies and healthcare regulations and laws, assistance in resolution of contract-related issues, completion of annual facility/payer credentialing applications, and other contracting-related tasks as applicable.Primary Job ResponsibilitiesConduct research, communications, and analysis to appropriately respond to or evaluate issues raised by Contracting staff or internal/external stakeholders and develop/facilitate responsesAssist in oversight of contract document control process to assure that contract documents are executed and filed in an accurate, consistent, and efficient manner, and filed/maintained in compliance with all applicable laws, regulations, and UW Medicine policiesComplete annual payer credentialing applications and forms for facilities, including communication with payers and internal stakeholders as necessaryEnsure that annual facility credentialing (including re-credentialing) applications and forms are accurately submitted within the timelines required by contracted managed payersMaintain accurate and consistent records of submitted credentialing applications and forms, payer responses and communications related to applications and forms, and all other relevant documentsAssist in negotiations with contracted managed care payers to secure favorable contract terms, including reimbursement rates, key contract language, and issue resolutionAssist in protests and/or appeals of adverse hospital and/or professional services claims decisions by payers, including research of relevant case facts, contracts, payer policies, or regulations, drafting of protest/appeal letters, and communications with UW Medicine and payer staffOrganize, oversee, attend, and/or participate in periodic payer operations meetings in collaboration with the Director of Provider RelationsTrack issues and resolutions to issues to possibly address in subsequent contract negotiation processesCommunicate with contracted payer and UW Medicine staff members as is required to accomplish the day to day duties and functions of the Contracting & Payer Relations DepartmentNegotiate and draft single case contracts with government and commercial managed care payers to accurately reflect all relevant agreement details, including but not limited to reimbursement terms, payment deadlines, and risk mitigation termsMaintain information and data related to single case contracts and provide regular reporting regarding single case contract volumes, related charges and reimbursement, and other key informationDraft and review managed care contract language as is required to accomplish day to day duties and functions of the Contracting & Payer Relations DepartmentRequired QualificationsBachelor's Degree in Business, Health Administration, Nursing or other related fieldsA minimum of two to three years experience in care/health insurance contracting and negotiations, healthcare provider reimbursement, health insurance payer/provider relations, and/or healthcare payer policies/processesEquivalent education and/or experience may substitute for minimum qualifications except when there are legal requirements, such as a license, certification, and/or registration.Compensation, Benefits and Position DetailsPay Range Minimum: $69,720.00 annualPay Range Maximum: $90,000.00 annualOther Compensation: -Benefits: For information about benefits for this position, visit First Shift (United States of America)Temporary or Regular?: This is a regular positionFTE (Full-Time Equivalent): 100.00%Union/Bargaining Unit: Not ApplicableAbout the UWWorking at the University of Washington provides a unique opportunity to change lives – on our campuses, in our state and around the world.UW employees bring their boundless energy, creative problem-solving skills and dedication to building stronger minds and a healthier world. In return, they enjoy outstanding benefits, opportunities for professional growth and the chance to work in an environment known for its diversity, intellectual excitement, artistic pursuits and natural beauty.Our CommitmentThe University of Washington is committed to fostering an inclusive, respectful and welcoming community for all. As an equal opportunity employer, the University considers applicants for employment without regard to race, color, creed, religion, national origin, citizenship, sex, pregnancy, age, marital status, sexual orientation, gender identity or expression, genetic information, disability, or veteran status consistent with UW Executive Order No. 81.To request disability accommodation in the application process, contact the Disability Services Office at View phone number on click.appcast.io or View email address on click.appcast.io considered for this position will be required to disclose if they are the subject of any substantiated findings or current investigations related to sexual misconduct at their current employment and past employment. Disclosure is required under Washington state law.
- Sunshine Behavioral Health is seeking a Utilization Review Coordinator in Washington state. The role focuses on communicating clinical information to managed care and payer services to obtain authorizations for treatment. The candidate should have UR experience, knowledge...Suggested
$55k - $65k
.... Full Time WA, US 3 days ago Requisition ID: 1338 Salary Range: $55,000.00 To $65,000.00 Annually POSITION SUMMARY: The Utilization Review Coordinator is responsible for communicating substance abuse and mental health clinical information to managed care/insurance...SuggestedFull timeFor contractors- ...data, and support surveying tasks in outdoor environments. The role requires 2+ years of relevant experience, a valid driver's license, and willingness to travel up to 50% with occasional night/weekend shifts. CDL not required. #J-18808-Ljbffr T2 Utility Engineers, Inc.SuggestedNight shift
- ...Friday, 8:00 AM - 5:00 PM PST (Pacific West Coast) The Clinical Reviewer supports the WISeR Prior Authorization Program by performing... ...0 coding. Ability to apply clinical judgment within regulated utilization management or prior authorization workflows. Proficiency with...SuggestedWork at officeRemote workMonday to FridayFlexible hoursAfternoon shift
- ...about Accenture's Oracle practice (.)You Are:A senior Oracle Utilities Integration Lead who brings both the architectural vision and... ...integration developers and analysts, setting delivery standards, reviewing technical designs, and ensuring adherence to integration...SuggestedFull timeWork experience placementLive inWork at officeLocal areaRemote work
$162.67k
...a Lead Pharmacist, UW Medicine Pharmacy Medication Policy and Utilization (Pharmacist 4).WORK SCHEDULEFull-Time / 40 hours per weekRotating... ...of medication use evaluation, formulary monographs and review documents for the UW Medicine P&T Committee and the UW Medicine...Full timeTemporary workWork at officeShift work- ...seeking a Hospital and Mental Health Residential (HMHR) Treatment Utilization Management Supervisor (Project/Program Manager III). This... ...assurance activities, including site visits, contract compliance reviews, invoice reconciliation, and other monitoring tasks as...Contract work
$94.4k - $266.3k
...Accenture's Oracle practice ( You Are: A senior Oracle Utilities reporting strategist who brings the vision and execution capability... ...resources, setting delivery priorities, quality standards, and review cadences. Engage client business stakeholders and IT...Work experience placementLive inWork at officeLocal area$33.56 - $38.46 per hour
...detail-oriented Leave & Accommodation Senior Specialist to lead the administration of FMLA, WA... ...and applicable state disability laws. Review medical documentation and collaborate... ...incidents. Data-driven Decision Making Utilizes HR metrics, dashboards, and workforce analytics...Flexible hours$17.13 - $19 per hour
...procedures. • Maintains photo equipment and utilizes store systems and technology to support... ...continuity during times when the Photo Specialist is not scheduled. • Follows company... ...role will remain open until filled. To review benefits, please click here jobs.walgreens...Hourly payWork experience placementSeasonal workFlexible hoursAfternoon shift$25 - $30 per hour
...E-Learning Specialist Hybrid • HD Fowler Company COR - Bellevue, WA 98006 Overview Salary... ...) position is responsible for writing, reviewing, editing, and updating content for company... ...written/audio/video-based material) utilizing e-tools available. Download ratified projects...Hourly payFull timeRemote workMonday to Friday$28.99 - $35.34 per hour
...match IMPACT YOU'LL MAKE: As a Recovery Specialist, you'll play a vital role in helping BECU... .... Locate and Reconnect with Debtors: Utilize skip-tracing techniques and available resources... ...efforts or impact the credit union. Review Vendor Activities: Evaluate vendor...Hourly payWork at officeRemote workMonday to Friday- ...ongoing behavioral health crises. Peer Specialists will work within a multi-disciplinary team... ...connections with program participants; utilize a trauma informed approach to assist participants... ...; participate in quality assurance reviews when assignedParticipate in verbal de-...Permanent employmentTraineeshipWork at officeFlexible hoursShift workNight shift
$23.5 per hour
...Job Description The Asset Protection Specialist is primarily responsible for preventing financial... ...assigned store/multiple stores. They utilize tools to minimize loss to the Company,... ...incidents of theft and fraud, reviewing CCTV and exception reports, monitoring the...Hourly payFull timeTemporary workPart time$125k - $205k
...System (ADMS) programs. This role serves as a trusted partner to utility clients and is suited to someone with a strong understanding of... ...from defined requirements through to testing outcomes. Review and assess technical documentation, including architecture diagrams...Work at officeLocal areaFlexible hours$24.65 - $38.63 per hour
...weekends! Typical Shift: 8:00am to 4:30pm PST The Behavior Specialist is responsible for conducting Cognitive Behavioral Therapy (... ...regulations and payer expectations. Communicate with Utilization Review department to provide information necessary to assist in facilitating...Full timeMonday to FridayShift work$24.65 - $38.63 per hour
...weekends! Typical Shift: 8:00am to 4:30pm PST The Behavior Specialist is responsible for conducting Cognitive Behavioral Therapy (... ...applicable regulations and payer expectations.Communicate with Utilization Review department to provide information necessary to assist in...Monday to FridayShift work$23 per hour
...Asset Protection Specialist Position Purpose: The Asset Protection Specialist is primarily... ...assigned store/multiple stores. They utilize tools to minimize loss to the Company, including... ...incidents of theft and fraud, reviewing CCTV and exception reports, monitoring the...Hourly payFull timePart time$34 per hour
...Seattle, WA. The Outreach & Engagement Specialist 2 (OES2) is a housing-focused outreach... ...aid individuals in housing attainment, utilizing the minimum assistance needed to address... ...laws. For further information, please review the Know Your Rights notice from the...Full timeTemporary workImmediate startMonday to Friday$83.2k - $119.6k
Job Description The Recruiting Relations Specialist - Unions is responsible for supporting... ...metrics including apprentice utilization, retention, recruiting activity, certifications... ...documentation Support audits, workforce reviews, and compliance reporting activities Education...For contractorsWork experience placementLocal area- ...more important and more complex accounts. Utilize underwriting tools to determine accurate... ...will produce an underwriting profit. Review submissions and identify exposure and risk... ...company for insurance, reinsurance, specialist advisory and investment operations around...Full timeRemote workWork from homeFlexible hours
$22.17 per hour
Job Description Fiscal Specialist 2. 100% FTE (40 hours per week) Day Shift Job Description... ...corrections, and status changes. Review timesheets, resolve payroll exceptions,... ...reports, projects, and committee activities. Utilize systems including UKG, Epic, Ariba,...Hourly payFull timeTemporary workWork at officeShift workDay shift- A leading AI research accelerator is seeking a medical professional to utilize their expertise in internal or emergency medicine by designing advanced clinical scenarios and evaluating AI-generated responses for accuracy. This fully remote contractor position requires an...For contractorsRemote work
$75k - $90k
...Court Filing, the ARC Filing & Docketing Specialist provides critical date management and... ...Calendaring/Critical Data Management (Docketing) Review documents, including but not limited to,... ...and detail-oriented work environment utilizing excellent judgment, initiative, decision...Full timeContract workWork experience placementLocal areaMonday to Friday- Now Brewing - Senior Equipment Specialist, Facilities Programs & Standards! #tobeapartner... ...analyze operational efficiencies, equipment utilization, and repair and maintenance trends.... .... Develops/participates in business reviews with stakeholders and author whitepapers...Temporary workLocal area
$50.49 per hour
.... Maintain examination facilities and equipment in accordance with our safety policy. Utilize multiple vascular testing instruments and identify when maintenance issues occur. Review patient medical history and supporting clinical information to ensure the appropriate...Hourly payDaily paidFull timeTemporary workWork at officeLocal areaShift workDay shift- Itron is innovating new ways for utilities and cities to manage energy and water. We create... ...today and tomorrow. Join us. The FP&A Specialist plays a key role in delivering accurate... ...month‑end close processes, including reviewing revenue recognition (recurring and...
$80.2k - $115.8k
...candidates to fill an open Project Control Specialist position! Specific details regarding the... ...obligations.Job Responsibilities Reviews project plans, schedules, cost estimates... ...required.Desired Qualifications Specific utility experience and experience with accounting...Contract workTemporary workFor contractorsWork experience placementLocal areaFlexible hours$45.9k - $61.3k
...Admissions Program Specialist 2, Enrollment Services Job ID: 15613 Location: Bellevue... ...fraudulent indicators. Request, collect, and review necessary documentation and manage... ...staff, faculty, and administrators, and utilize forward-thinking methods to address and...Full timeTemporary workPart timeWork at officeFlexible hours- ...Senior Specialist Customer Account-Amazon Foods you love. Brands you trust. And a career... ...the Amazon Coffee & Beverage portfolio utilizes tools available as well as builds, creates... ...needs Leads monthly forecasting reviews and recommendations across the portfolio...Work experience placementImmediate start
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Review Specialist. Be the first to apply!
- configuration specialist Seattle, WA
- localization specialist Seattle, WA
- intervention specialist Seattle, WA
- investigations specialist Seattle, WA
- ecommerce specialist Seattle, WA
- workforce management specialist Seattle, WA
- community health promotion specialist Seattle, WA
- title specialist Seattle, WA
- infectious disease specialist Seattle, WA
- credit specialist Seattle, WA


