Utilization Review Coordinator
Coastalharbor
Responsibilities Coastal Harbor Health is currently seeking a Utilization Review Coordinator Per Diem to coordinate and direct utilization review functions, monitoring the utilization and continuum of services to optimize reimbursement. Coastal Harbor Health System is comprised of a 114‑bed hospital for children and adolescents, providing both short‑ and long‑term inpatient care, and a 50‑bed inpatient hospital serving men and women, ages 18 and up. We offer compassionate patient care to those who need it the most, serving not only local patients, but also those located across the country. Our hospitals are conveniently located in beautiful, historic Savannah, GA in a quiet setting that provides unparalleled anonymity and privacy, enabling patients to concentrate on treatment. Job Duties / Responsibilities Perform the utilization and review process, for continued stay, in an appropriate and timely manner. Maintain appropriate records of the review process for the purpose of preparing and submitting appeals to third‑party payors. Respect the confidentiality of patient and employee information. Supervise the reception of requests for information from medical records of patients in person, by mail or phone, from various sources from the community at large, and assure that authorizations are properly executed (according to HIPAA guidelines, federal, and state laws) for these requests for client information. Perform other duties related to the department as necessity dictates. Benefit Highlights Challenging and rewarding work environment Competitive compensation, Paid Time Off Excellent Medical, Dental, Vision and Prescription Drug Plans 401(k) with company match and discounted stock plan About Universal Health Services Qualifications Possess a degree in nursing, psychology, or other appropriate/related field. Masters degree required; Licensed or Licensed eligible. One to Two years related experience and/or training preferred. Must have some management experience with a demonstrated leadership ability and skills to write reports and communicate effectively. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success. #J-18808-Ljbffr
$20 - $30 per hour
...industry by delivering exceptional care, utilizing state-of-the-art facilities, and... ...Requirement: None Responsibilities Utilization Review on Behalf of the Clinics: Prescreen referrals... ...with the primary treating clinicians. Coordinate Peer-to-Peer (P2P) Review preparation...SuggestedRemote work- ...Utilization Review Coordinator Per Diem Coastal Harbor Health is currently seeking a Utilization Review Coordinator Per Diem to coordinate and direct Utilization Review functions, monitoring the utilization and continuum of services to optimize reimbursement. Coastal...SuggestedDaily paidTemporary workReliefLocal area
- ...A healthcare provider in Savannah, GA is seeking a Per Diem Utilization Review Coordinator. The role involves coordinating Utilization Review functions, ensuring timely and appropriate processes, and maintaining confidentiality. Candidates must possess a Master's degree...SuggestedDaily paid
- Integrated Management Strategies (IMS) is seeking an experienced Sr Review Coordinator to join our healthcare consulting practice. This role is fully remote within the US and focuses on utilization review of plans of service for home and community-based programs, impacting...SuggestedRemote jobContract workWork from home
- ...Humana is seeking a Remote UM Administration Coordinator to provide administrative support for utilization management programs and processes. You will review information, maintain records, perform data entry, and coordinate communications with internal teams and external...SuggestedRemote work
$80 per hour
...healthcare professionals experienced in prior authorization, utilization management, clinical review, medical necessity criteria, payer authorization... ..., payer operations, medical necessity review, or care coordination is highly relevantClinical licensure such as...Hourly payPart timeFor contractorsWork at officeRemote workFlexible hours- 100 LCMC Health is seeking an RN for Utilization Review to support patient throughput and physician communication while ensuring payer requirements... ...per CMS and payer guidelines. The role involves coordinating with care teams to prevent denials and documenting workflows...Shift workWeekend work
- Phoebe Putney Memorial Hospital in Albany, GA, is seeking an RN UR Specialist to manage utilization review activities, secure authorizations, and support medical necessity justification for hospital services. You will liaise with insurance payers and care management staff...Full time
$20 - $30 per hour
A behavioral healthcare organization is seeking a Utilization Review Specialist to conduct clinical auditing and negotiate authorizations... ...experience. Responsibilities include conducting live reviews, coordinating with clinical teams, and ensuring compliance with...- University of Miami Health System seeks a full-time Utilization Review Case Manager to work remotely. The role reviews patient charts for... ...prior authorization, concurrent and retrospective utilization, coordinating with the care team for timely and appropriate care. You...Remote jobFull time
- ...headquarters in New York, with regional headquarters in London and Hong Kong.What You Will Be Doing:The position of Managed Review Coordinator will be instrumental in supporting our Managed Review Project Managers. The MRC will assist several Project Managers execute...Full timeTemporary workInternshipWork at officeLocal areaWorldwideWeekend work
- Humana is seeking an UM Administration Coordinator to support utilization management operations. You will review information, maintain records, and coordinate communications with internal teams and external stakeholders. The role emphasizes accuracy, timeliness, and adherence...Remote jobWork at office
- SUNY Downstate Health Sciences University seeks a full-time TH Utilization Review & Quality Assurance Senior Coordinator / Rehabilitation Case Manager to lead clinical reviews, discharge planning and care coordination within the Orthopaedic Surgery & Rehabilitation Medicine...Full time
Coordinator to lead civil and utility modeling for infrastructure projects across NYC's five boroughs. The role focuses on 3D modeling of underground utilities, site work, and civil systems, with proficiency...
- ...RN - Utilization Review The Utilization Review RN is responsible for reviewing medical records to determine the appropriateness and medical necessity of hospital admissions and continued stays. The nurse collaborates with providers, insurance companies, and case managers...
- ICON plc is seeking a Central Review Coordinator to join our Central Review Services team. You will manage study trackers, monitor deadlines, and coordinate reviewer assignments while ensuring on-time data review and high-quality data management. The role requires CRO/...Remote job
- ...A leading healthcare solutions company is seeking an experienced Utilization Review Nurse to improve patient care through home-based services. Responsibilities include processing authorization requests, ensuring compliance with Medicare guidelines, and collaborating with...Remote work
- ...LCMC Health in Louisiana seeks an RN for Utilization Review to support patient throughput, facilitate physician communication, and determine... ...workflows in EPIC, identify barriers in treatment plans, coordinate care to prevent payer denials, and perform timely status conversions...Shift workNight shiftWeekend work
$30 - $38 per hour
...A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Hourly payPart timeRemote work$35 - $43 per hour
...5.00/hr - $43.00/hr Job Title Clinical Review Nurse – Concurrent Review Location: Remote... ...Nurse – Concurrent Review will perform utilization management functions to ensure members... ...or discharges to ensure timely coordination between care levels and facilities. Collaborate...Remote work$140 - $145 per hour
...Oscar is hiring a Physician Reviewer to join our Utilization Management Team. You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. This remote role is open...Hourly payRemote workWeekend work$34 - $40 per hour
...to LPN's & RN's About the Role Medix is seeking an experienced Utilization Review Nurse to support our mission of improving patient care through home-based health services. In this role, you will coordinate and review patient authorizations, ensure compliance with Medicare...Full timeRemote work- Job Description Summary Your job is more than a job The RN Utilization Review position allows for necessary support for patient throughput,... ...patient status in accordance with CMS and payer guidelines Coordinate efforts for prevention of payer denials Performs timely status...Shift workNight shiftWeekend work
- Youritrecruiter UM Nurse role involves conducting clinical reviews to assess medical necessity and efficiency of services requested by providers and members. It supports the health plan’s utilization management aligned with clinical guidelines and accreditation standards...
$10k
## Utilization Review RN - PT - Day - Utilization Resource Mgmt Pennington NJApplylocations: Pennington, NJtime type: Part timeposted on: Posted Todayjob requisition id: JR109737Capital Health is the region's leader in providing progressive, quality patient care with significant...Full timeTemporary workPart timeWork at officeLocal areaImmediate startFlexible hoursNight shift- LCMC Health is seeking an RN Utilization Review nurse in Louisiana to support patient throughput and coordinate care with physicians and payers. You will perform care reviews, determine medical necessity, and document in EPIC, ensuring regulatory compliance and high-quality...Afternoon shift
- A healthcare staffing firm is seeking a skilled Utilization Review RN to join their team. This fully remote position requires a valid PA RN license and prior experience in insurance utilization review. Responsibilities include conducting clinical reviews, applying evidence...Remote job
- Capital Health is seeking a part-time Utilization Review RN in Pennington, NJ. The role involves performing a variety of utilization management activities to ensure quality, clinical, and cost-effective outcomes. Key responsibilities include assessing treatment plans,...Part time
- Brighton Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate with partners, and ensure timely, compliant documentation and communications with...Remote jobWork at office
$45 - $50 per hour
...Greenlife Healthcare Staffing is looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical studies. With a competitive pay of $45 - $50...Hourly payRemote work
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