Home Health Utilization Review Specialist
Berkshire Health Systems
Berkshire Medical Center in Pittsfield, MA seeks an Utilization Program Specialist to evaluate the necessity and appropriateness of services, supporting case management and reimbursement aligned with BVNA standards. The role coordinates medical coding and supports clinical managers to ensure compliant, cost-efficient home health care. Requirements include a minimum of 3 years in a certified home health agency, MA RN licensure, and Home Health coding certification. #J-18808-Ljbffr Berkshire Health Systems
- ...CVS Health Corporation is seeking an RN Concurrent Review Nurse to join a remote team delivering inpatient clinical expertise... .... This role offers work-from-home scheduling, Monday–Friday, with... ...inpatient nursing, and 2+ years in utilization management or discharge planning,...Work from homeRemote workMonday to FridayWeekend work
$60k - $62k
Job Description Remote- Work From Home, Jackson, Jackson, Michigan, United States... ...and expertise. Position Overview The Utilization Review Specialist is responsible for all aspects of the... ...may change as needs evolve. Coronis Health is committed to creating a diverse and...Work from homeFull timePart timeRemote workFlexible hours$65k - $85k
Utilization Review Specialist (RN) - Work From Home (Florida-Based Candidates Only) Concierge Home Care | Work From Home Opportunity - Must Reside in Florida... ...Review Specialist (RN) to join our remote home health team. This role is ideal for an RN with strong OASIS...Work from homeRemote workMonday to FridayShift workWeekend workWeekday work- ...The Arizona Health Care Cost Containment System (AHCCCS) is seeking a Behavioral Health Prior Authorization Utilization Review Consultant. The role focuses on monitoring, evaluating, and approving or denying payment for medical and behavioral health services for the Fee...SuggestedRemote work
- ...FHE Health in the United States seeks an experienced Utilization Review Specialist to manage clinical authorization processes, ensuring timely, accurate, and compliant communications with insurance payers. You will support patient access by securing initial and continued...SuggestedRemote work
- ...Recovery Unplugged is seeking an experienced Utilization Review Specialist to join our team. This remote, part-time role focuses on obtaining and... ...ideal candidate has prior utilization review or behavioral health experience, strong knowledge of payer requirements, excellent...Part timeRemote workWeekend work
- ...Hansei Solutions is seeking an Utilization Review Specialist to act as the vital link between insurance payors and treatment facilities, advocating for clients to secure maximum authorized treatment days. The role emphasizes communication, organization, data entry, multitasking...Remote work
- ...About Us FHE Health ("FHE") is a nationally recognized behavioral healthcare institution... ...For We are seeking an experienced specialist who is passionate about making a... ...field required preferred. 2-3 years of utilization review experience in behavioral health, addiction...Daily paidFull timeRemote work
$24 - $26 per hour
...Utilization Review Specialist – Behavioral Health (Remote) PHP/IOP | Full-Time | Monday–Friday, 9 AM–5 PM ET | $24–$26/hour About the Role Principles Recovery Center (PRC) are hiring a Utilization Review (UR) Specialist to manage insurance authorizations for adolescent...Full timeRemote workMonday to Friday$90.9k - $129.9k
...career development. Summary Review and evaluate prior authorization submissions utilizing multiple computer systems, and... ...expect in this role ~100% Remote home office. ~ Full-time position.... ...employer match comprehensive health benefits educational...Full timeWork experience placementRemote workHome officeFlexible hours- ...support in monitoring the Mental Health Plan and Drug-Medi-Cal Organized... ...System (DMC-ODS), including review of medical records to ensure proper utilization of treatment resources and quality... ...behavioral health treatment. UR Specialists also interpret, advise and train...Contract workLocal areaRemote workTrial periodFlexible hours
- ...Sedgwick is seeking a Telecommuter RN for Utilization Review in the United States. The role requires an active RN license, an associate degree (bachelor’s preferred), and 4 years of related experience with utilization review. Certification is a plus. The position offers...Remote work
- ...Ascension is seeking a Registered Nurse for Utilization Management in a remote-capable role. This position focuses on reviewing admissions and service requests for medical... ...diploma, with benefits including comprehensive health coverage, retirement plans, PTO, and...Remote work
- ...Cincinnati Children e s Hospital Medical Center is seeking a Remote Utilization Review professional to perform admission and continued stay reviews using InterQual, ensuring medical necessity and appropriate level of care.The role collaborates with Admitting, Financial...Remote work
$69.39k - $88.61k
...Cincinnati Children’s is seeking an experienced Utilization Review professional for a remote role in the United States. The position supports case management, authorization, compliance, and education within the Utilization Review department. The role requires a Bachelor...Full timeRemote work- ...West River Health Services is a mission-driven Critical Access Hospital and Rural Health... ...of the HIM Manager, monitors utilization of resources, risk management, and quality... ...Perform preadmission and retrospective chart reviews - Coordinate with discharge planning on...
- Principles Recovery Center in Florida is seeking a remote Utilization Review Specialist to manage insurance authorizations for adolescent and adult behavioral health, substance use, and co-occurring treatment in a PHP/IOP setting. You will verify benefits, complete prior...Remote job
- Bradford Health Services is seeking an Utilization Review Specialist in Birmingham, AL. The role ensures medical necessity and regulatory compliance across patient care, collaborating with providers, insurers, and case managers to optimize outcomes. The candidate will review...Remote job
$48.78 - $73.17 per hour
...glad you are interested in joining Sutter Health! Organization ABSMC-Alta Bates Herrick Campus... ..., need for continued stay, and proper utilization of physician, nursing, and ancillary services. Responsible for concurrent review on specific patients. Develops, coordinates...Full timeWork at officeLocal areaMonday to FridayShift workWeekend work- ...in 2003, provides administrative services for behavioral health facilities in the Northeast, mid‑Atlantic, and Southeast regions... ...and mental health outpatient clinics. Position Title: Utilization Review Specialist Responsibilities Initiate pre‑certification and...Full timeWork at officeVisa sponsorshipWeekend work
- ...Pavilion Behavioral Health System in Champaign, Illinois, is seeking a Full-time Utilization Review Coordinator to ensure accurate chart reviews and to obtain hospital stay certifications from insurers. The role supports behavioral health and addiction treatment across...Full time
- ...(in days) to receive an alert: Lexington Health is a comprehensive network of care that includes... ...and concurrent stay medical record review to determine appropriateness of admission... ...or LMC-related information with others. Utilizes the service recovery process to resolve complaints...Full timeTemporary workWork at officeFlexible hours
- ...Praesum Healthcare: Position Title: Utilization Review Specialist Founded in 2003, Praesum Healthcare provides administrative services for... ...to come. Praesum currently provides services to behavioral health facilities providing all levels of care from inpatient psychiatric...Hourly payFull timeWork at officeVisa sponsorshipWeekend work
- ...Overview Vantage Point Behavioral Health Hospital is seeking a Full Time Utilization Review Specialist at our Fayetteville, AR location. PURPOSE STATEMENT: Proactively monitor utilization of services for patients to optimize reimbursement for the facility....Full timeWork at officeLocal area
- ...Evolve Treatment Centers in West Palm Beach, Florida, is seeking a full-time Utilization Review Specialist. This role involves initiating pre-certification authorizations, communicating with facilities, and maintaining patient census. Candidates should have a High School...Full time
- ...the communities we serve. How you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient admissions and... ...medical, dental, and vision plans, plus flexible-spending and health- savings accounts Competitive paid time off...Temporary workFlexible hours
- ...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...Relief
- ...New Vista Behavioral Health is seeking a detail-oriented Corporate Utilization Review Specialist to support utilization review and insurance authorization processes across multiple behavioral health facilities. Candidates must hold an active clinical license as an RN...
- ...Gosnold is seeking an Utilization Review Specialist to perform pre-certification and concurrent reviews, working closely with clinical teams to coordinate... ...s degree and at least two years of clinical experience in health services, with knowledge of levels of care and medical...
- WNS HealthHelp (A Capgemini Company) is seeking a licensed registered nurse to perform concurrent inpatient utilization reviews from a remote setting. You will collaborate with attending physicians and care teams to determine medical necessity and appropriate level of care...Remote job
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