Hybrid Utilization Review & Care Authorization Specialist
New Horizons of the Treasure Coast and Okeechobee
New Horizons of the Treasure Coast and Okeechobee seeks a Utilization Review Specialist to manage patient accounts requiring authorization. Responsibilities include initiating pre-certification, reviewing EMR for care level criteria, and communicating with insurers to obtain approvals. This hybrid role requires strong organizational, verbal and written communication, and problem-solving skills to ensure compliance with CMS and agency policies. #J-18808-Ljbffr New Horizons of the Treasure Coast and Okeechobee
- TurningPoint Healthcare Solutions is hiring a Utilization Review Nurse to work remotely. The ideal candidate must hold a valid LPN or RN license and possess strong critical thinking and clinical expertise. Responsibilities include performing initial clinical reviews, assisting...SuggestedRemote job
- ...Logistics Healthcare Operational Care Specialist to support time‑critical,... ...productivity improvements Utilize internal systems (including... .... Job requires U.S. work authorization without employer... ...decisions are made by human reviewers. Equal Employment Opportunity...SuggestedLocal areaShift workWeekend workAfternoon shift
- ...our clinical and revenue integrity teams. This role focuses on reviewing patient charts for accuracy, completeness, and compliance... ...clinical staff to support clean claims Collaborate and assist our Authorizations and Referrals Dept Participate in quality improvement and...SuggestedFull timeWork at office
- ...seeking a qualified clinical nurse for a utilization management role. Candidates should... ...utilization management within a managed care environment. The position requires collaboration... ...to ensure quality care and involves reviewing medical necessity. Applicants can reach...Suggested
- ...management guidelines. Candidates should have strong experience in utilization review or case management and excellent communication skills. This position requires the ability to analyze data and coordinate care effectively within a multidisciplinary team. #J-18808-Ljbffr...Suggested
- ...timely, and compliant medical necessity reviews. This role provides day-to-day oversight... ...and client-specific expectations. The Utilization Review (UR) Nurse Team Lead provides clinical... ...skills, and expertise in acute care utilization management to promote high-quality...Work experience placementWork at officeShift workWeekend work
- Health Business Solutions LLC seeks an experienced Utilization Review Nurse in New York to provide clinical guidance, drive appropriate level of care, and support revenue cycle efficiency. You will conduct medical record assessments, coordinate care with interdisciplinary...
- Job Summary We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will... ...medical records to ensure patients are receiving appropriate care at the correct level of service. Care Coordination: Collaborate...Work experience placement
$20.9 - $31.35 per hour
Job Description Summary The Patient Care Specialist III performs advanced administrative and... ...insurance eligibility, obtains required authorizations, and documents verification results... ...and uploading documents into the EHR. Reviews patient accounts for outstanding balances...Work at office- ...position requires strong experience in performing chart audits and reviewing medical records, particularly with HEDIS standards. Candidates... ..., along with the ability to communicate effectively and utilize Microsoft Office tools. Educational qualifications may include...Work at office
- UF Health is seeking an RN Utilization Management professional to evaluate... ...and appropriateness of care. The role involves coordinating... ...treatment plans, and communicating authorization decisions to support timely... ...with 3+ years in utilization review or case management and strong...
- ...to maintain compliance with utilization management guidelines and optimizing... ...plans for effective patient care and resource utilization. Requires clear communication of authorization decisions and ongoing... ...Three (3) years of utilization review, case management, or third-party...
$26.41 - $51.49 per hour
...for clinical member services review assessment processes. Responsible... ...integrated delivery of care across the continuum. Contributes... ...reviews to determine prior authorization/financial responsibility for... ...Molina care model. Adheres to utilization management (UM) policies and...Remote jobHourly payWork experience placementWork at office$26.41 - $51.49 per hour
...Healthcare in California, MO is seeking a Clinical Member Services Reviewer. The role includes assessing clinical service requests, ensuring... ...and at least 2 years of experience in hospital or managed care settings. Competitive pay is offered, ranging from $26.41 to $51...Hourly pay- ...Job Description Job Description Community Home Health Care seeking to hire Personal Care Aides (PCA or HHA) to join our growing... ...Job Candidates: Must be at least 18 or older Must be authorized to work in the U.S. No experience necessary, just compassion...Weekly payWork at officeLocal areaImmediate startFree visaFlexible hours
- RISE Personal Care Specialists engage in one-on-one interactions with patients and/or customers from the time they enter the retail area until... ...of consumption, and safety as part of patient interaction Utilize product and consumption-method knowledge to recommend a safe...Part timeWork at officeLocal areaShift workNight shiftWeekend workDay shift
- ...enhance lives, and preserve the planet". What do our Plant Care Specialists do? The primary purpose of this role is to visit various customer... ...possibly including Workday, Loop, and HireVue. These systems utilize text messages to communicate with you throughout the...Full timePart timeLocal areaImmediate startMonday to Friday
$19 per hour
Youth Care Specialist - Youth Behavioral Health Location: Broward, FL Department: Operations Job Type: Full-Time Evening & Overnight / Sunday... ...on movement, security, contraband, headcounts, and reporting Utilize group counseling techniques, individual relationships,...Full timeImmediate startShift workNight shiftAfternoon shift- ...alternative application process. Medical Coding Specialist Full Time Miramar, FL, US 12 days ago... ..., and claims processing. This is a hybrid position initially required in office presence... ...allows. DUTIES AND RESPONSIBILITIES: Reviews the patient 's medical record for...Full timeWork at officeRemote workMonday to Friday
$2,640 - $3,168 per month
...Fresh provides boutique hotel-level home care for residential clients, combining... ...stay organized Ability to lift 25-35 lbs Authorized to work in the U.S. Comfortable using a... ...Route Coordinator Expanded Home Services Specialist Base Pay (W2, before taxes): $2,640-$3,...Full time$19 - $21 per hour
...Medical is a primary care solution challenging the... ...known as Lab Services Specialist/ Member Support... ...to your daily work to utilize your strengths and develop... ...medical record and consult review, billing inquiries,... ...confirm that you are authorized to work in the U.S. Please...Hourly payFull timeTemporary workPart timeWork at officeRemote workShift work- ...is seeking a clinically oriented pharmacist to provide specialized medication management in ambulatory settings. The role includes reviewing regimens, patient education, and ensuring safe, effective therapy. You will participate in quality initiatives, mentor residents,...
- ...Repayment Services program office after review of the EDRP application. Duties VA Careers... ...and services in specialty areas - utilizing outcome evaluations to improve treatment... ...096F Relocation/Recruitment Incentives: Authorized EDRP Authorized: Former EDRP participants...Work at officeRemote workRelocation packageMonday to Friday
- ChenMed is seeking a Network Specialist to join our clinical operations team. The role emphasizes direct patient care in ambulatory settings, with responsibilities spanning medical history review, exams, data interpretation, and treatment planning. Applicants should hold...
- POSITION SUMMARY The Senior Managed Care Contracting Specialist is responsible for the implementation, monitoring, and ongoing administration of... ...managed care issues across internal and external departments. Reviews and evaluates payer reimbursement for compliance with...Full timeContract workWork experience placementWork at officeShift work
- ...offering affordable primary care and preventative services. For... .... Culture & Community: Many reviews say that PMG has a “friendly,... ...State Statutes and/or board of authority. Licenses & Certifications... ...variety of scents and odors Must utilize universal precaution in...Full timeWork at officeLocal areaImmediate startWeekend work
- ...of life for the people entrusted to our care. An unwavering commitment to our service... ...Responsibilities: Prepares patients for procedures by reviewing medical history, draping and positioning... ...and vascular interventional procedures (utilizing surgical sterile technique). Reviews...Work experience placementWork at officeRelocation packageShift workWeekend work
- ...of life for the people entrusted to our care. An unwavering commitment to our service... ...hours. Prepares patients for procedures by reviewing medical history, draping and positioning... ...and vascular interventional procedures (utilizing surgical sterile technique). Reviews...Work experience placementRelocation packageShift work
$32.79 - $60.99 per hour
...treatments, adjusting care plans based on patient... ...relation to the technology utilized on the unit Excellent... ..., exercises authority, and functions independently... ...Care Clinical Nurse Specialist (CCNS) [Preferred] Certified... ...law. Applicants may review general information...Full timeWork experience placementLocal areaShift work- Schulte Hospitality Group is seeking a dynamic, service-oriented Room Utility to join our team! Schulte Hospitality Group is an organization... ..., with daily pay! Free telemedicine and virtual mental health care access for all associates starting day one! Multiple health...Hourly payDaily paidFull timeImmediate startFlexible hours
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