Utilization Review Specialist
Virtual Vocations Inc
To ensure the delivery of medically necessary and efficient healthcare services, the full-time Utilization Review Specialist will evaluate patient records and treatment plans, collaborate with healthcare providers and insurance companies, and maintain compliance with regulatory standards while working remotely. Key responsibilities: Review and analyze medical records and clinical documentation to assess the necessity of healthcare services Coordinate with healthcare providers and insurance representatives to clarify treatment details and obtain additional information Make informed decisions regarding the authorization or denial of services based on clinical guidelines and regulations Required qualifications: Bachelor's degree in a healthcare or related field At least 2 years of experience in utilization review, case management, or clinical healthcare roles Strong knowledge of medical terminology, clinical procedures, and healthcare regulations Familiarity with insurance authorization processes and healthcare reimbursement models Excellent analytical and organizational skills
Vacancy posted 13 hours ago
Similar jobs that could be interesting for youBased on the Utilization Review Specialist in United States vacancy
$93.73k - $146.08k
...Sturdy Health in Attleboro, Massachusetts, is seeking a Utilization Review Specialist with expertise in utilization management and patient status determination. The role requires collaboration with various departments to improve UM processes and ensure compliance with...SuggestedSturdy Health
Attleboro, MA5 days ago- ...Under the direct supervision of the HIM manager, the UR specialist monitors the utilization of resources, risk management and quality of care for patients... .... Excellence in Practice Performs preadmission review on admissions when required by insurance companies/agencies...Suggested
West River Health Services
Hettinger, ND7 days ago - ...Working remotely in a full-time capacity, the Behavioral Health Utilization Review Specialist will manage the authorization of treatment through insurance and managed care companies, performing pre-certification, concurrent, and appeal reviews while ensuring compliance...SuggestedFull timeRemote work
Virtual Vocations Inc
United States5 days ago $30 - $45 per hour
...leading healthcare consulting agency is seeking an Operations Specialist III for a contract opportunity in Long Beach, CA. This role... ...Medi-Cal operations, along with experience in Epic EHR and Utilization Review. The selected candidate will perform chart reviews, ensure documentation...SuggestedHourly payContract workRemote workPyramid Consulting
Long Beach, CA2 days ago- ...Utilization Review Specialist The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient, and compliant with regulatory standards. This position involves thorough evaluation of...SuggestedRemote work
Bradford Health Services
United States5 days ago - ...Utilization Review Specialist/Behavioral Health Substance Abuse (Remote) The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies. The role involves providing appropriate client information...Remote jobFlexible hours
- The Lead Utilization Review & Utilization Management Specialist at WESTCARE NEVADA INC leads the UR/UM team, providing clinical oversight, supervision, and mentorship to UR/UM staff while ensuring regulatory compliance across care levels. This senior role coordinates admissions...
- ...ensure our client’s revenue cycle is managed in the most efficient and streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will utilize his or her knowledge and skills to review clinical...Work at officeRemote workFlexible hours
Spectrum Billing Solutions
Skokie, IL1 day ago - ...The County of Riverside is hiring a Utilization Review Technician to support the UR Case Management Division at RUHS Medical Center in Moreno Valley. In this role, you'll perform clerical tasks and act as a key liaison between providers and insurance plans, ensuring optimal...
County of Riverside
Moreno Valley, CA1 day ago - ...A healthcare service provider in Alabama is looking for a Utilization Review Specialist. This entry-level role involves ensuring healthcare services provided to patients are necessary and compliant. Candidates should have a Bachelor's degree in Nursing or Health Administration...Full time
Bradford Health Services
Warrior, AL2 days ago - ...and/or placement waivers are secured and reviewed, with all deadlines met. Negotiate and... ...the adoption process. Experience with utilization management in behavioral and/or medical... ...Confidential Information: The Utilization Review Specialist will have access to confidential...Contract work
Our Community Our Kids
Fort Worth, TX5 days ago - ...We are driven by a profound commitment to prioritize your well‑being so you can provide exceptional care to others. As a Utilization Review Specialist joining our team, you’re embracing a vital mission dedicated to making communities healthier. Join us on this meaningful...Temporary workPart timeRelief
Memorial Physician Practices
Fort Worth, TX2 days ago - ...Overview Fully On-Site Role Utilization Review Specialist Members of our team Enjoy: Working with a highly engaged staff Healthy staffing levels Flexible scheduling Career growth Competitive compensation Health, Vision, Dental, k, and Paid Time Off UKG Wallet – We’ve partnered...Flexible hours
Springstone
Olathe, KS1 day ago $33.22 - $44.85 per hour
...trauma, spinal cord injury, amputation or orthopedic injury. Salary Range $33.22 - $44.85 per hour How You’ll Contribute Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine...Hourly payFull timeTemporary workFlexible hoursLifePoint Health
Holyoke, MA3 days ago- ...Hospital, Wichita, KS, US 2 days ago Requisition ID: 9252 UR Specialist – Join Camber and Make an Impact At Camber Mental Health ,... ...while making a meaningful difference every day. Job Summary The Utilization Review department manages all aspects of a patient’s stay related...Full timeWork at officeRemote workMonday to Friday
KVC Health Systems
Wichita, KS2 days ago - ...every client’s ability to achieve recovery and rebuild meaningful, engaged lives in their communities. Job Summary The Utilization Review (UR) Specialist is responsible for ensuring that clients receiving substance use disorder (SUD) treatment services meet clinical...Local area
Lighthouse Behavioral Health Solutions
Columbus, OH3 days ago $22 - $24 per hour
...Position Summary Reporting to the Utilization Review Manager, the Utilization Review Specialist will coordinate reviews of group renewal information, process claims for medical necessity, and determine whether authorizations are on file. Make determinations for claims...Hourly payTemporary workFlexible hoursCobalt Benefits Group LLC
Saint Paul, MN1 day ago$55k - $70k
...Utilization Review Specialist – Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote Salary: $55K - $70K About the Role As a Utilization Review Specialist, you will play a pivotal role in ensuring the efficient and effective utilization of healthcare...Remote workFlexible hoursICBD
Florida, NY1 day ago$65.52k - $95.5k
...Position Summary The Utilization Review Specialist will ensure regulatory compliance with CMS Conditions of Participation with regard to Utilization Management. Perform Utiliztion Review according to CMS and commercial payor guidelines. Participate in denial / appeal process...Monday to FridayShift workDay shiftECU Health
Greenville, NC1 day ago$93.73k - $146.08k
## Utilization Review SpecialistApplylocations: Attleboro, MAtime type: Full timeposted on: Posted Todayjob requisition id: R9109Scheduled Weekly Hours: 40-• The Utilization Review (UR) Specialist has well-developed knowledge and skills in areas of utilization management...Night shiftSturdy Memorial
Attleboro, MA5 days ago- ...Avenues Recovery Center is Now Hiring: Utilization Review Specialists Avenues Recovery Center is a nationwide network of drug and alcohol rehabilitation centers with eighteen locations across seven states. We provide highly individualized, evidence-based treatment in...Full timeTemporary workWork at officeImmediate startFlexible hours
avenuesrecovery
Toms River, NJ5 days ago - ...Oakwood Springs in Oklahoma City is seeking an Utilization Review Specialist to evaluate admissions and ongoing stays, advocating for patient access and coordinating with managed care to obtain necessary approvals. You will work with an interdisciplinary team to ensure...
Memorial Physician Practices
Oklahoma City, OK1 day ago $55k - $70k
...Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote Salary $55K - $70K Who We Are Exact Billing Solutions is a unique team of revenue‑cycle management professionals specializing in the substance use disorder, mental...Work at officeRemote workFlexible hoursExact Billing Solutions
Florida, NY2 days ago$27 - $38 per hour
...Join to apply for the Utilization Review Specialist role at Tully Hill Treatment & Recovery Do you have a passion for helping others? Tully Hill Treatment and Recovery is dedicated to the belief that substance use disorder is a disease – chronic, progressive and above...Hourly payFull timeContract workTemporary workWork experience placementTully Hill
Tully, NY2 days ago$18.5 - $26.04 per hour
...General Summary Responsible for supporting the utilization review system including data analysis, report writing, and program improvement. UR Specialist will develop and maintain a VOD Tracking and Receipt system. UR Specialist will maintain an expert level review of client...Work experience placementSheppard Pratt
Towson, MD1 day ago- ...About the job Utilization Review Specialist Join Our Team: As a Utilization Review Specialist, you will play a pivotal role in managing and performing various processes related to medical records requests, retrospective review requests, and chart appeals. If you are organized...
Staffosaurus
Boynton Beach, FL1 day ago - ...The Utilization Review Specialist works under the direction of the Utilization Management Manager and acts as an interdisciplinary team member within the Utilization Management Department. The Specialist is responsible for providing verification of benefits, authorization...Shift work
St. Charles Health System
Sunriver, OR3 days ago - ...Licenses:None requiredEducation:Associates or Bachelors level LPN or RN and/or Bachelors or Masters level CADC/LADC with 2 years utilization review experience, preferred experience working with individuals with psychiatric orsubstance use disorderExperience and...Work at office
WESTCARE NEVADA INC
Henderson, NV4 days ago $28 - $50 per hour
...Utilization Review Specialist (Flexi) Job Category: Administrative Professional Requisition Number: UTILI003276 Part-Time On-site Chesapeake, VA 23320, USA Pay or shift range: $28 USD to $50 USD The estimated salary range is provided in accordance with Virginia Pay...Part timeShift work- ...Mass Digital Health is seeking a Utilization Review Nurse in Quincy, Massachusetts. This role involves evaluating patients for appropriate admission type and collaborating with healthcare teams to manage care effectively. The ideal candidate will have a strong clinical...
Mass Digital Health
Quincy, MA1 day ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Review Specialist. Be the first to apply!
Related searches
- specialist teaching assistant United States
- order management specialist United States
- measurement specialist United States
- senior systems specialist United States
- facility management specialist United States
- human factors specialist United States
- leasing specialist United States
- order specialist United States
- funding specialist United States
- assessment specialist United States