Utilization Review Specialist
Virtual Vocations Inc
To support effective utilization management, the part-time Senior Utilization Review Specialist will conduct concurrent and retrospective reviews of hospital services, ensuring compliance with medical necessity and payer authorization while collaborating with clinical teams in a fully remote capacity. Key Responsibilities Perform concurrent and retrospective utilization reviews for inpatient, observation, and outpatient cases using approved criteria and clinical judgment Collaborate with physicians and care management teams to clarify documentation and support appropriate care progression while identifying and escalating potential risks Serve as a senior clinical resource, providing guidance on complex review questions and participating in quality audits and process improvement initiatives Required Qualifications Current, unrestricted RN license Five or more years of acute-care hospital experience, including at least three years in utilization review or a closely related function Demonstrated experience applying medical-necessity and level-of-care criteria Working knowledge of payer authorization requirements and denial-prevention practices Strong clinical judgment and ability to manage a high-volume caseload independently
- ...SummaryUnder the direct supervision of the HIM Manager, monitors utilization of resources, risk management, and quality of care for... ...Responsibilities- Perform preadmission and retrospective chart reviews- Coordinate with discharge planning on medical necessity and level...Suggested
- ...Utilization Review Specialist Ethos Risk Services is a leading insurance claims investigation and medical management company committed to providing better data that translates into better decision-making for our clients. We are at the forefront of innovation in our...SuggestedFull timeWork at officeRemote work
- ...At Bradford Health Services, we don't just invest in our patients-we invest in our people. About the Role: The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient, and...SuggestedPart time
- ...Avenues Recovery Center in New Jersey is seeking a Utilization Review Specialist to join our corporate team. The role supports client authorizations, level-of-care determinations, and coordination across clinical and billing teams to maintain accurate documentation and...Suggested
- ...Copper Springs East Behavioral Health is seeking an Utilization Review Specialist in Gilbert, AZ. You will facilitate clinical reviews for admissions and stays, interface with payers for authorization, and advocate for patients to obtain needed services. A clinical license...SuggestedFull time
- ...Utilization Review SpecialistPosition Function: Responsible for ensuring that youth receive the most appropriate level of residential services... ...to Confidential Information: The Utilization Review Specialist will have access to confidential records including youth files...Contract work
- ...Travel Non-patient Care (Utilization Review) ASUPSupplemental Health Care is hiring experienced travel Non-patient Care (utilization Review) ASUPs for contracts at a hospital in Washington, DC. With over 40 years as a nationally recognized staffing partner, we connect...Contract workImmediate startShift work
- ...We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As Utilization Review Specialist joining our team, you’re embracing a vital mission dedicated to making communities healthier. Join us on this meaningful...Full timeTemporary workFlexible hours
- A leading medical review organization is seeking Board-Certified physicians in Gastroenterology for a flexible remote opportunity. This role requires conducting independent Utilization Reviews for just 1-2 hours per week, with no minimum commitment. Candidates must have...Remote workFlexible hours
- ...Medical Center Health System in Odessa, TX seeks a detail‑oriented support clerk to assist the Utilization Management department with utilization reviews, data collection, and care coordination activities. The position requires a high school diploma, at least one year...
- ...Utilization Review SpecialistAbout View Behavioral HealthWe are proud to serve as a trusted resource for our community, providing high-quality mental health care with compassion and integrity. Our Long Beach facility currently operates as a 79-bed adult voluntary acute...Local areaWeekend work
- ...Berkshire Hathaway Homestate Companies in Omaha is seeking a Utilization Review Specialist to join the Medical Management team. You will triage, review, and coordinate authorization requests to ensure medical treatments comply with state laws and company policies. You...
- ...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
- ...Utilization Review SpecialistThe Utilization Review Specialist processes all insurance authorizations for partial hospitalization programs, intensive outpatient programs and outpatient programs across business entities to ensure timely and appropriate services for clientele...Casual workLive inWork at officeFlexible hoursAfternoon shift
- ...Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an opening for a Utilization Review Specialist in Omaha to join its Medical Management team. The individual ensures that medical treatment requests from providers are medically appropriate and reviewed...Work at office
$80 per hour
...part-time consulting opportunity for United States-based healthcare professionals experienced in prior authorization, utilization management, clinical review, medical necessity criteria, payer authorization workflows, documentation review, and healthcare operations.This...Hourly payPart timeFor contractorsWork at officeRemote workFlexible hours- ...Overview Utilization Specialist On-site Madison, WI Full time Why Join Competitive compensation with industry leading annual performance-based... ...and the facility professional clinical staff. Conduct reviews, in accordance with certification requirements, of insurance...Full timeWork at officeLocal area
- ...Spectrum Billing Solutions is seeking an ABA Utilization Review (UR) Specialist to join their team. This fully remote or hybrid position involves reviewing clinical information and obtaining authorizations for ABA services. Candidates should have 3-5 years of relevant...Remote work
$26 - $33 per hour
...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...Hourly payFull timeTemporary workPart time$35 - $45 per hour
...Neier Inc. is looking for an experienced RN / Utilization Review Nurse in Sacramento for a potential contract to hire position. This role involves reviewing medical records and treatment requests to ensure compliance with healthcare regulations. The ideal candidate will...Hourly payContract work- ...Memorial Physician Practices is hiring a Utilization Review Specialist in Tucson, Arizona, who will facilitate clinical reviews and advocate for patients accessing mental health services. This PRN role involves working with managed care organizations and is vital for ensuring...Relief
- ...Bradford Health Services in Jacksonville seeks a detail-oriented Utilization Review Specialist to evaluate medical records, treatment plans, and clinical data to ensure services are medically necessary and compliant with regulations. You will collaborate with providers...
- ...Utilization Review Specialist – North Little Rock, AR (72113) Are you an experienced healthcare professional looking for an opportunity to make a difference in patient care management? We’re seeking a Utilization Review Specialist to join our team in North Little Rock,...Work at office
- ...ABA Utilization Review Specialist Spectrum Billing Solutions offers industry-leading revenue cycle management services for healthcare providers. Our team has deep industry knowledge, technology, and experience to ensure our client's revenue cycle is managed in the most...Work at officeRemote workFlexible hours
- ...Description Join our team at Company and build a meaningful career in employee benefits solutions. As a Healthcare Utilization Review Specialist, you’ll play a vital role in ensuring our clients and members receive the right care at the right time through customized, self...Full timeTemporary workSummer workFlexible hours
- ...Berkshire Hathaway Homestate Companies, Workers Compensation Division, in Omaha seeks a Utilization Review Specialist to join the Medical Management team. You will review medical treatment requests for medical appropriateness in line with state laws and company policies...
$38.5k
...Utilization Review SpecialistThe Utilization Review (UR) Specialist supports the facility's utilization management processes. Responsibilities include preparing documentation for pre-certification of admissions and continued stays, serving as a liaison with gatekeepers...Hourly payFull timeWork at officeMonday to FridayFlexible hoursWeekend work- ...care to patients with bleeding, clotting and other hematologic disorders, and to their families. What You Will Do As the Utilization Review Specialist, you will be responsible for managing prior authorizations, medical necessity reviews, and payer-related requirements...Work at office
$55k
...Utilization Review SpecialistJoin our team today and immerse yourself in a rewarding career for years to come!The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies. The Utilization Review...Full timeWork at officeMonday to Friday$55k - $65k
...process. 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...Full timeFor contractors
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