Utilization Review Specialist
Southeastrans Inc
Summary: The primary responsibility of this role consists of reviewing member transportation requests that are over the contractual mileage guidelines. ESSENTIAL FUNCTIONS
- Reviewing and making approval/denial determinations for all member transportation requests that are outside of the geographical mileage guidelines and reviewing requests to non-covered Medicaid services and or locations.
- Review for approval/denial determinations for facilities wishing to participate in the organization's Subscription/Standing Order Transportation Program.
- Process subscription/Standing order transportation requests from approved facilities for NEMT.
- Investigates transportation provider complaints lodged against Medicaid members during transportation and issuance of Member Warning Letters as warranted.
- Responsible for completing the three departmental reports: daily denial letters, member no-show letters, and monthly denial summary.
- Run Monthly Denial Summary Report for covered regions and send to the client.
- Knowledge of Medicare and Medicaid, community resources, dialysis, and the nursing home placement process.
- Must possess entry to mid-level proficiency in Microsoft Word and Excel.
- Excellent written and verbal communication skills.
- Possesses and demonstrates multi-tasking skills in a high-stress environment while working with multiple internal departments, as well as external entities.
- Analytical thinker with good judgment.
- Well-organized, self-directed individual, who is flexible and takes direction well.
- Possesses a high level of interpersonal skills to handle sensitive and confidential situations.
- High School graduate or equivalent.
- 2 years of customer service experience and or employment in the healthcare industry.
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Utilization Review Specialist in Villa Rica, GA vacancy
- Verida Inc. in Villa Rica, GA is seeking a Full-Time Admin Support Worker to review member transportation requests and ensure adherence to mileage guidelines within Medicaid-related programs. The role requires 2+ years in healthcare customer service, strong MS Word/Excel...SuggestedFull time
- ...Asset Protection Specialist | Home DepotPosition Purpose:The Asset Protection Specialist is... ...their 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...Suggested
Home Depot
Villa Rica, GA4 days ago - ...Douglasville/Carrollton/Troup-Coweta Counties as a Construction Specialist, where you'll play a crucial role in restoring properties to... ...with clients and team members to provide project updates. Utilize tools and equipment safely and efficiently for construction tasks...SuggestedFlexible hoursShift work
SERVPRO of Douglasville/Carrollton/Troup-Coweta Counties
Villa Rica, GA1 day ago $15 - $17.5 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...SuggestedHourly payWork experience placementSeasonal workFlexible hoursAfternoon shiftWalgreens
Douglasville, GA1 day ago- ...LLC is one of North America's largest wire and cable producers. Southwire and its subsidiaries manufacture building wire and cable, utility products, metal-clad cable, portable and electronic cord products, OEM wire products and engineered products. In addition,...SuggestedFor contractorsWork at officeShift workWeekend work
- ...verification, and related documentation, ensuring accurate and timely patient flow. The incumbent will handle POS collections, work output review, and collaborate with hospital staff to maintain high-quality patient service in a fast-paced environment. #J-18808-Ljbffr Tanner...
- ...Job Description Job Description Job Description: The General Utility Associate helps the facility in several ways. They work with production to ensure production lines have materials, completes paperwork, maintain housekeeping, and can assist with quality checks...Work experience placementShift work
Zobility
Douglasville, GA3 days ago $49.4k
...departmental subject matter experts; initiates routine content reviews to ensure accuracy and timeliness. Monitors and resolves technical... ...and resources. Knowledge of computer systems and software utilized in a business environment. Knowledge of video software....Full timeWork at officeRemote work- ...Center Operations to maximize scheduling and real-time resource utilization; analyze and recommend the part-time, flexible, and full-time... ...to communicate and fill schedules and handle exceptions. Review ongoing performance results to targets. Takes corrective measures...Full timeContract workPart timeLocal areaImmediate startFlexible hours
Verida Inc
Villa Rica, GA13 days ago - Benefits: Dental Insurance, Medical Insurance, Vision Insurance, Life Insurance, Retirement, Paid Time Off, Other. Must-Haves: MUST HAVE Bachelor's Degree in an Engineering discipline or other scientific program applicable to the safety field. ...Work at officeLocal areaShift work
Macpower Digital Assets Edge
Villa Rica, GA2 days ago - ...Safety Specialists conduct all safety related functions in compliance with Company, Federal and State Regulations. They are responsible... ...Safety related functions including, but not limited to, accident reviews, annual reviews, and remedial log training and simulator...Work at officeFlexible hours
Werner Enterprises
Lithia Springs, GA3 days ago - ...Vast array of voluntary benefits.Position Overview:The Front End Specialist assists customers and helps to maintain the store appearance.... ...pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor....Part timeWeekend workAfternoon shift
Ollie's Bargain Outlet, Inc.
Douglasville, GA4 days ago - DICK’S Sporting Goods Distribution Center is hiring a Maintenance Tech II to keep our high-volume operation running safely and efficiently. You will perform preventive and corrective maintenance on conveyors, material-handling systems, and facility equipment, troubleshoot...
- Safety Specialists conduct all safety related functions in compliance with Company, Federal and State Regulations. They are responsible... ...Safety related functions including, but not limited to, accident reviews, annual reviews, and remedial log training and simulator...Work at officeFlexible hours
- ...Retail Zone Specialist Join our team and live the Ollie-tude! (Ollie's Core Values) BE A TEAM PLAYER - Associates are expected to be... ...pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor....Part timeWeekend workAfternoon shift
- Tanner Health System is seeking a CT Technologist to perform CT procedures, maintain equipment records, and participate in continuing education to maintain registry. The role requires caring for patients across age groups and ensuring quality control within the radiology...
- ...technical expertise, and building a high-performing team. The EH&S Specialist III performs advanced safety inspections, leads incident... ...and toolbox talks to field crews and supervisors • Develop and review project-specific site safety plans and job hazard analyses • Ensure...Full timeFor contractorsLocal area
- ...entry point or growth path within the organization. Responsibilities include providing accurate parts solutions, engaging customers, utilizing product knowledge with team members, and operating POS and inventory tools to maintain a fast-paced, customer-focused environment....
- A leading home improvement retailer is seeking an Asset Protection Specialist responsible for preventing financial loss due to theft and fraud. The role involves monitoring physical security, preparing detailed case reports, and working with law enforcement. Candidates...
$46.2k - $96.2k
We are seeking a Metrology Technician to join IQVIA Laboratories at Ithaca. We hire passionate innovators who drive healthcare forward through thoughtful and inclusive collaboration. If you want to discover a career with greater purpose, join us as we transform and accelerate...Full timePart timeFor contractorsWork at officeImmediate startRemote workWork from homeWorldwideIQVIA Laboratories
Villa Rica, GA1 day ago- SERVPRO of Douglasville/Carrollton/Troup-Coweta Counties is seeking a Construction Specialist to restore properties and support customers through the construction process. You will assess damage, educate clients, and coordinate with project managers to ensure timely, quality...
- Tanner Health System in Villa Rica, GA seeks a patient access specialist to facilitate efficient intake, verify insurance, and complete required documentation. You will handle pre-registration, registration, and cash collection while upholding regulatory compliance and...
$19.16 - $24.9 per hour
...Follows safety procedures, report unsafe activities and conditions, utilizes safety equipment, and monitors work environment to ensure... ...handbooks, reference materials, manuals, or other documentation; reviews, completes, processes, forwards, or retains as appropriate.****...Hourly payFull timeTemporary workFlexible hours- ...for Gas Reimbursement & Public Transportation related issues; ensure issues are resolved to member and/or Client satisfaction. Reviews and notifies Call Center regarding scheduling errors as they are related to GR & PT assigned trips for immediate correction and modification...Immediate start
Verida Inc
Villa Rica, GA5 days ago $22.17 - $28.83 per hour
...SpecialistSalary Range $22.17 - $28.83 HourlyDESKTOP SUPPORT SPECIALIST – POLICE DEPARTMENTDepartment: Information Technology Department... ...applications, wiring, power connections, and other technology utilized in support of municipal law-enforcement and public-safety...Full timeWork at officeRemote workCity of Villa Rica
Villa Rica, GA1 day ago- ...Southwire and its subsidiaries manufacture building wire and cable, utility products, metal-clad cable, portable and electronic cord... ...completes emergency and urgent (break-in) jobs in an efficient manner. Reviews work packages of planned work orders and recommends necessary...Temporary workFor contractorsWork at officeShift workWeekend work
Southwire
Villa Rica, GA4 days ago - ...to trip disbursement. Communicates areas of accountability and performance expected of personnel. Conducts employee performance reviews and ensures staff performance targets are met on a daily, weekly, and monthly basis. Reviews ongoing performance results to targets...Work at officeLocal areaImmediate start
Verida, Inc.
Villa Rica, GA4 days ago - ...service to our residential or commercial pest control customers utilizing an Integrated Pest Management approach (IPM) . This is a... ...initial 3-minute, mobile-friendly application so that we can review your information. We look forward to meeting you! #ArrowExterminators...Hourly payFull time
Arrow Exterminators
Villa Rica, GA12 days ago $45k - $85k
...0 - 85,000.00 (US Dollar)About the Role Were seeking motivated and detail-oriented individuals to join our team as Remote Travel Specialists. In this role, you will assist clients with planning and booking unforgettable trips from flights and hotels to cruises, tours, and...Remote workWork from homeMagical Destinations Travel
Douglasville, GA2 days ago$30 - $40 per hour
...OSHA regulations. Stop others performing “at risk” behaviors. Utilize Good Manufacturing Practices (GMP’s), Perform both proaction... ...Computerized Maintenance Management System (CMMS) to initiate, review and sign-off work orders in the system. This includes the...Hourly payFull timeFor contractorsAll shiftsSugar Foods LLC
Villa Rica, GA11 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Review Specialist. Be the first to apply!
Related searches
- coding specialist Villa Rica, GA
- consulting specialist Villa Rica, GA
- ecommerce specialist Villa Rica, GA
- specialist Villa Rica, GA
- welding specialist Villa Rica, GA
- transportation specialist Villa Rica, GA
- records management specialist Villa Rica, GA
- adoption specialist Villa Rica, GA
- amazon specialist Villa Rica, GA
- infection control specialist Villa Rica, GA