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
$90.9k - $129.9k
...Health Day Treatment and In- Home Family Therapy. There are no direct patient interactions for this role, rather you will provide utilization review and quality assurance.Your role in our missionReview and evaluate prior authorization submissions utilizing multiple computer...SuggestedFull timeRemote workHome officeFlexible hours- ...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
- ...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
- ...Under the direct supervision of the HIM Manager, monitors utilization of resources, risk management, and quality of care for patients... ...Responsibilities - Perform preadmission and retrospective chart reviews - Coordinate with discharge planning on medical necessity...Suggested
- ...To support the Ethos Medical Management Team, the full-time Utilization Review Specialist will ensure the efficient and timely processing of Utilization Management and Independent Review requests remotely, while maintaining compliance and delivering exceptional client...SuggestedFull timeWork at officeRemote work
$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 placement- ...Job TitleUtilization Review (UR) SpecialistJob DescriptionBe inspired. Be rewarded. Belong. At Emory Healthcare.At Emory... ...mentorship, development, and leadership programs… and more!The Utilization Review (UR) Specialist is a Registered Nurse responsible for conducting thorough...Work at officeRemote work
- ...About the Role The Utilization Review Coordinator plays a critical role in ensuring that patients at our facility receive the appropriate level of care while managing treatment costs. This position involves coordinating, assessing, and authorizing treatment plans, collaborating...Full timePart timeWeekend work
- ...certified programs: a Part 820 Residential Reintegration Program and a Part 822 Outpatient Rehabilitation Program. As a Utilization Review Specialist, you will play a vital role in ensuring that clinical services are medically necessary, appropriately authorized, and compliant...Work at office
- ...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...
- ...Healthcare Utilization Review SpecialistJoin 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...Full timeTemporary workSummer holidayFlexible hours
$16.74 - $26.92 per hour
...Utilization Review (UR) Intake SpecialistThe Utilization Review (UR) Intake Specialist provides staff support services including typing reports and correspondence, file handling and forms completion in addition to answering incoming telephone calls, supporting the goals...Minimum wageFull timeWork at officeLocal areaRemote workFlexible hours- ...skills, compassion, and dedication will make a remarkable difference in the lives of those we serve. How You'll Contribute Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine...Full timeTemporary workPart timeShift work
- ...hospitals to help improve the health of individuals and the quality of life in our community. New Horizons is seeking an Utilization Review Specialist , who will be responsible for following up on patient accounts when authorization for stay is required, initiate pre-...Local area
- ...Utilization Review Specialist At the Innovative Hematology (IHI), we offer a future where people with rare blood disorders flourish. Our experts provide the highest quality comprehensive services and holistic care to patients with bleeding, clotting and other hematologic...Work at office
- ...profound commitment to prioritizing well‑being so that you can provide exceptional care to others. How you’ll contribute A Utilization Review Specialist who excels in this role: Facilitates clinical reviews for all patient admissions and continued stays. Analyzes patient...Full timeTemporary workPart timeReliefFlexible hours
$40.17k
...Utilization Review SpecialistREM Community Services, a part of the Sevita family, provides community-based services for individuals with intellectual... ...with the Company's mission.SummaryThe Utilization Review Specialist is responsible for proactive planning measures, accurate...Work experience placementWork at office- ...Position Summary: The Utilization Review Specialist/Outcomes Specialist conducts concurrent and retrospective review functions in support of the hospital Utilization Review Program and makes appropriate referrals to designated Physician Advisors. Qualifications...Flexible hours
- ...Purpose Statement Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Purpose Statement... ...organizations and the facility professional clinical staff. Conduct reviews, in accordance with certification requirements, of insurance...Work at officeLocal area
- ...Mesa Springs in Fort Worth, TX is seeking a dedicated Utilization Review Specialist to ensure appropriate inpatient and outpatient authorizations, accuracy in denials and certifications, and effective communication with physicians and care teams. You will apply clinical...
$35 - $40 per hour
...Utilization Review Specialist Meridian, ID Job Title: Utilization Review Specialist Location: Remote Schedule: Monday-Friday 8am-5pm MST Compensation: $35-40/hour Northpoint Recovery Holdings, LLC began 2009 as Ashwood Outpatient and officially launched...Full timeTemporary workWork at officeRemote workMonday to Friday- ...and provide professional purpose. Together we facilitate healing, one patient at a time. We are looking for a Full Time Utilization Review Specialist! The Utilization Review Specialist assesses, plans, implements and evaluates the internal processes to limit possible recoupment...Full timeWork at officeImmediate startFlexible hours
$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- ...ABA Utilization Review SpecialistSpectrum Billing Solutions offers industry-leading revenue cycle management services for healthcare providers... .... We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will utilize his...Work at officeRemote 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
$20 - $30 per hour
...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...- ...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...
$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 hours- ...HUMBLE VASCULAR SURGICAL CENTER INC in Addison, Texas, is seeking a dedicated RN Case Manager to oversee utilization reviews and discharge planning. The role involves ensuring compliance with medical necessity guidelines while collaborating with physicians and interdisciplinary...
$26 - $28 per hour
...Utilization Review Specialist About View Behavioral Health We 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...Hourly payLocal areaShift workWeekend work
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