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 Guidelight Health
$39.4 - $53 per hour
...healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should... ...Time and every other weekend We are seeking Virtual Utilization Review Specialists to join our team. Essential job function include:...SuggestedTemporary workWork at officeLocal areaRemote workMonday to FridayWeekend work$50k
...Employer Industry: Behavioral Healthcare Management Why consider this job opportunity Starting pay up to $50,000 per year,... ...Responsibilities) Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the multidisciplinary...SuggestedRemote work- ...Coronis Health is seeking a remote Utilization Review Specialist to manage treatment authorization for behavioral health and substance abuse, interfacing with insurance and managed care entities. The role covers pre-certification, concurrent reviews, and appeals with a...SuggestedRemote work
- Ensemble is seeking Virtual Utilization Review Specialists to join our remote team. You will evaluate medical necessity, coordinate with physician advisors, and collaborate with care management and financial clearance teams to ensure high-quality patient care and appropriate...SuggestedRemote job
- ...Humana Healthy Horizons in Kentucky seeks a Utilization Management Behavioral Health Professional 2 to support coordination, documentation, and communication of medical services and benefit determinations. The role requires interpreting criteria and policies with independent...Suggested
$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- ...related Streaming Services. Standards & Practices Associates review high profile national advertising campaigns to ensure... ...communication, claim support, and other documentation obtained and utilized in the clearance process is an integral part of this role. The...Contract workFixed term contractWork at officeRemote work
- ...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
- ...PAHub & Prior Authorization Specialist serves as a trusted consultant... ...calls, workshops, business reviews, and operational meetings.... ...Optimization Assess customer utilization of PAHub and identify opportunities... ...5+ years of experience in healthcare operations, prior...Local areaRemote work
$70k - $180k
...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...Remote jobPermanent employmentFull timeWork at officeLocal areaRelocation packageNight shift- ...concurrent, retrospective, and Medicare reviews to determine medical necessity and... ...and support concurrent and retrospective utilization reviews Identify quality concerns, report... ...or Case Management experience within a healthcare system or insurance organization...
$15 - $18.32 per hour
...data collaboration platform trusted for healthcare. Guided by our mission to make the world... ...Basic computer proficiency. Comfortable utilizing phones, fax machine, printers, and other... ...from these requirements will be reviewed by Datavant Human Resources and determined...Hourly payWork experience placementWork at officeMonday to Friday$19.83 per hour
...We are currently seeking a Health Care Specialist (HCS) to work full-time at our Bay Ridge... ...to 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$15 - $18.32 per hour
...data collaboration platform trusted for healthcare. Guided by our mission to make the world... ...Basic computer proficiency. Comfortable utilizing phones, fax machine, printers, and other... ...exempted from these requirements will be reviewed by Datavant Human Resources and...Hourly payFull timeTemporary workWork experience placementWork at officeMonday to Friday$18.92 - $23.46 per hour
...“Best Place to Work Modern Healthcare” - Join a team where people... ...Summary: The Payment Posting Specialist will work in a team-based environment... ...problems from documentation review, determine lasting solutions... ...knowledge and skill in utilizing the MS Office suite of...Full timeTemporary workLocal areaImmediate startFlexible hours$57.7k
...care, helps members to coordinate their healthcare services and navigate the healthcare system... ...telephonic contact with each member to review progress and assess the potential for... ...Management Certification Skills Proficiency in utilizing PC‑based system application and...Remote jobTemporary workFor contractorsWork at officeLocal area$10k
...dramatically expanding access to healthcare by reimagining the patient... .... As a Patient Engagement Specialist I, you are often the first... ...Specialist I Your day will begin by reviewing and following up on inbound... ...Throughout the day you will utilize deep prospecting techniques...Flexible hours$42 per hour
...Medicare Annual Wellness Visit Specialist - PRN ~ Full-time WHO... ...powered, performance-driven healthcare company dedicated to... ...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- ...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
- 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
$96.3k - $178.8k
The PositionSurgical Device Specialist (SDS), Ophthalmology - NY MetroAn ever-transforming healthcare landscape requires a high level of agility and flexibility to navigate... ...relationships, conduct quarterly business reviews, and leverage marketing materials for consultative...Full timeLive inLocal areaRelocation packageNight shiftWeekend workAfternoon shift- ...Associate Vice President, Space Planning & Utilization About the Company Acclaimed clinical research & medical care center Industry... ...Databases Specialties medicine education healthcare science and biomedical research Business Classifications...
- ...GroupAt CMI Media Group, we are delivering healthcare marketing at the speed of life. Our... ...looking for a proactive, detail-oriented Specialist, Audit & Compliance to join our team. In... ...and track PBC (Provided by Client) lists, review submissions for completeness, and manage...Flexible hours1 day per week
$145k - $155k
...here. Medtronic is a global leader in healthcare technology with a Mission to alleviate... ...outcomes. Join Medtronic as an EP Mapping Specialist and be at the forefront of transforming... ...addition, your driving record will be reviewed and will be considered as part of your...Full timeWork experience placementH1bWork at officeLocal areaImmediate startRemote workWorldwideFlexible hoursNight shift- DescriptionThe Dialysis Equipment Specialist (DES) is responsible for the maintenance, upkeep... ...in the safety, preparation, and utilization of all chemicals used in the dialysis unit... ...innovation as we work together to transform healthcare. We encourage all team members to...Hourly payTraineeshipLocal areaWeekend work
$135k - $140k
...here. Medtronic is a global leader in healthcare technology with a Mission to alleviate... ...addition, your driving record will be reviewed and will be considered as part of your... ...infectious disease and radiation Clinical Specialists are required to be within their assigned...Full timeWork experience placementH1bWork at officeLocal areaImmediate startRemote workWorldwideFlexible hoursNight shift$120k - $125k
...here. Medtronic is a global leader in healthcare technology with a Mission to alleviate... ...outcomes. Join Medtronic as an EP Mapping Specialist and be at the forefront of transforming... ...addition, your driving record will be reviewed and will be considered as part of your...Full timeWork experience placementH1bWork at officeLocal areaImmediate startRemote workWorldwideFlexible hoursNight shift$67.63k
...quarterly mental health workshops and conducts comprehensive case reviews to achieve goals of the program, appropriately, and ensuring... ...emerging mental health trends in collaboration with internal teams. Utilize insights to inform responsive programming and service delivery...$50k
...bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment... ...including DRG Validation, Cost Outlier and Readmission reviews. The Appeals Specialist I is responsible for performing triage, review, analysis...Contract workWork experience placementRemote work$160k - $180k
...DescriptionWhat is the opportunity?The Associate, Corporate Banking - Power, Utilities and Infrastructure (“PU&I”) candidate will be responsible for... ...opportunity at RBC. Qualified applicants may be contacted to review their resume in more detail.Job SummaryJob number: R-0000182882...Full timeWork experience placementFlexible hours
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