Utilization Review Specialist
$38.5kOk.Gov
Utilization Review Specialist Agency 452 MENTAL HEALTH AND SUBSTANCE ABUSE SERV. Supervisory Organization GMH - Utilization Review Job Posting End Date Refer to the date listed at the top of this posting, if available. Continuous if date is blank. Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above. Full/Part-Time Full time Job Type Regular Job Description About the Position : The 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, HMOs, OHCA, and insurance providers, and maintaining daily logs and tracking spreadsheets. The UR Specialist collects and analyzes data related to medical record documentation compliance, inappropriate admissions, delays in services and discharges, premature discharges, effectiveness of discharge planning, and the over- or under-utilization of resources. The role may also involve coordinating patient transfers when appropriate. In addition, this position contributes to quality improvement initiatives and ensures compliance with JCAHO, Title XIX, and other regulatory standards. The UR Specialist collaborates closely with the Director of Operations, as well as medical, clinical, and reimbursement staff, to minimize potential loss of revenue. The UR Specialist participates in interdisciplinary treatment teams, clinical management meetings, and agency meetings, and performs other duties as assigned. This is an on-site position that requires direct patient interaction. Job Type/Salary: Job Type: Full-time, Non-Exempt Work Schedule: Monday - Friday, 8:00 a.m. - 5:00 p.m. Annual Salary: $38,500 ($18.50 per hour) Minimum Qualifications and Experience: Bachelor's Degree in social work, psychology, or related field plus one year of technical clerical, administrative, secretarial, or general office work. Equivalent combination of education and experience is accepted. Preferred: Experience in a mental health setting. Special Requirements: Valid driver's license and the ability to travel as needed for job-related duties. Must pass pre-employment and pre-placement drug and alcohol screening due to the safety-sensitive nature of this position. Why Join Us? Generous Benefits: Annual base salary of $38,500 plus a generous benefits allowance. Comprehensive Health Coverage: A wide choice of health insurance plans with no pre-existing condition exclusions. Flexible Spending Accounts: Options for healthcare and dependent care expenses. Ample Time Off: 11 paid holidays, 15 days of vacation, and 15 days of sick leave in the first year. Retirement Savings Plan: With a generous company match to help secure your future. Employee Assistance Program: Support when you need it. Longevity Bonuses: For years of dedicated service. Training Opportunities: Continuous learning and development for CEU requirements. About us: Griffin Memorial Hospital (GMH) is located in Norman, Oklahoma, and serves all 77 counties in Oklahoma as a Department of Mental Health and Substance Abuse Services (ODMHSAS) treatment center for adults. Griffin Memorial Hospital is a 120-bed acute psychiatric hospital serving persons aged 18 and over with severe mental illness and provides in-patient hospital care for those in need of mental health & substance abuse services. Drug and Alcohol Pre-employment and Preplacement Testing: Upon a conditional offer of employment, applicants for safety sensitive positions shall be required to submit to urinalysis to test for drugs. Appointment to a safety sensitive position shall be contingent upon a negative drug test result. THIS AGENCY REQUIRES COVERAGE 24 HOURS, 7 DAYS PER WEEK. WORK HOURS AND LOCATION MAY VARY DEPENDING ON BUSINESS NECESSITY. EMPLOYEES MAY BE REQUIRED TO WORK WEEKENDS AND OVERTIME. Reasonable accommodation to individuals with disabilities may be provided upon request. An Equal Opportunity Employer. Equal Opportunity Employment The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability. Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub . #J-18808-Ljbffr
- ...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...SuggestedTemporary workPart timeRelief
$55k
...Join our team today and immerse yourself in a rewarding career for years to come! As the Utilization Review Specialist, you will work in an office based setting located in Trenton, Mercer County NJ. The Utilization Review Specialist is responsible for all aspects of the...SuggestedExtra incomeWork at office- ...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...Suggested
- ...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,...SuggestedWork at office
- ...University of South Alabama Health System seeks an experienced Registered Nurse for Utilization Review to perform quality reviews, prior authorizations, and discharge planning. The role collaborates with physicians and care teams to ensure compliant, timely patient care...Suggested
- Utilization Review Specialist- Healthcare | Raleigh Oaks Behavioral Health | Garner, North Carolina About the Job The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved...Temporary workWork at office
$110k
...outcomes in the expected time frame and with the most efficient utilization of resources. Carries out activities related to utilization... ...physician regarding appropriate documentation for justification. Reviews the patient’s plan of care in conjunction with the clinical...Daily paidFull timePart timeFlexible hoursShift work- ...is seeking a qualified RN to support clinical member services review and assessment processes. You will verify medical necessity, align... ...integrated care across the continuum. The role emphasizes utilization management, adherence to timelines, and collaboration with multidisciplinary...
- ...Comagine Health seeks Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This full-time, remote position requires Alabama licensure and focuses on compliant, cost-effective...Full timeContract workRemote work
- Utilization Review Coordinator Opportunity - Fuller Hospital is a 109-bed licensed, private psychiatric facility located in South Attleboro, Massachusetts providing inpatient and outpatient behavioral health services to residents of Massachusetts and Rhode Island. Inpatient...Full timeLocal area
- ## Utility Project Support Specialist (Field Based)Applylocations: Rolling Meadows, Illinois: Kankakee, Illinoistime type: Part timeposted on: Posted... ...Please submit your resume and brief cover letter. Based on review of these responses, shortlisted candidates will be...Part timeFixed term contractCasual workRemote workShift work
$45.76k - $73.22k
## Utilization Management SpecialistApply: Remote Flex - North Carolina: Full time: Posted... ...*We’re hiring a Utilization Management Specialist to join the Government Pharmacy UM Operations... ...for the completion of non-clinical reviews and communication to customers to...Full timeWork at officeLocal areaRemote workFlexible hours2 days per week- ...accommodation or an alternative application process. Clinical Reviewer Full Time Professional Houston, TX, US 2 days ago Requisition... ...populations preferred. Previous experience with clinical review, utilization review, care management, admissions evaluations, medical...Full time
$17 - $18.15 per hour
## Patient Access Associate Specialist - Full TimeApply: Oconto Falls, WI: HSHS - St. Clare... ...receiving, and processing physician orders, and utilizing an overlay tool while providing... ...forms implemented for future services.* Reviews eligibility responses in insurance verification...Full timeWork at officeShift workWeekend workDay shift$100k - $110k
...performs pre-bill inpatient medical record reviews to identify coding opportunities,... ...and ensure credentials remain current Utilize Enjoin tools and coding resources, including... ...choiceassessment Phone call with a Talent Acquisition Specialist Video interview with the Hiring Manager...Local areaRemote workMonday to Friday- Lakeside Behavioral Health System in Memphis, TN seeks an UM Coordinator who can assess psychiatric diagnoses, determine appropriate level of care, and advocate for patient length of stay and benefits. You’ll work with hospital teams and insurers to optimize reimbursement...
$17 - $18.15 per hour
...insurance information, receiving, and processing physician orders, and utilizing an overlay tool while providing excellent customer service as... ...Consent forms, and all forms implemented for future services. Reviews eligibility responses in insurance verification system and...Work at officeLocal areaRemote work- ...continuum of specialty programs throughout our inpatient, partial and outpatient services. The Utilization Management Coordinator performs timely, daily clinical reviews with all payer types, to secure authorization for initial and continued treatment based on payer’...Full timeLocal areaShift workDay shift
- UnitedHealth Group is seeking a licensed psychologist to perform peer reviews across Commercial, Medicaid, and Medicare cases, applying clinical criteria and benefit plan requirements to determine coverage decisions. The role emphasizes collaboration, adherence to guidelines...Remote work
$110k - $130k
...collaborative environment? As an experienced Pay Specialist II, you will have the ability to share... ...analysis at the security and fund level utilizing the PAY forecasting tool, to be used by... ...for new data workflows, conduct reviews of all testing results to ensure data integrity...Local area- ...believe in an environment that allows you to thrive both personally and professionally. Position Overview We are seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess the medical necessity and quality of healthcare services through prospective,...Full timeContract workRemote work
- The Bristal in Bethpage, NY is seeking a responsible Kitchen Utility Worker/Dishwasher to support our busy kitchen in a luxury assisted living community. You will perform cleaning, washing, and maintenance tasks, work in a fast-paced environment, and help with heavy lifting...Shift workWeekend work
$64.35k
...Behavior Intervention Specialist Under supervision of BIS leadership, Behavior Intervention... ...Analyzes data from multiple sources and utilizes findings to conduct research on related... ...in interdisciplinary meetings and case reviews, including scheduled Person-Centered...Full timeReliefMonday to FridayFlexible hoursAfternoon shift- ...seeks to recruit a Performance Management Specialist to provide support to the Performance... ...Director and other managers, upon request; - Review processes, procedures and practices, and... ...to maximize the team's efficiency; - Utilize ePerformance and electronic evaluation...Work at office
$100k - $140k
...fulfilling career.The Learning Systems specialist is responsible for the administration, optimization... ...ensures these systems are effectively utilized to deliver high-quality learning... ...specifically Docebo, Coursera and Harvard Business Review.Strong understanding of digital learning...Full timeContract workWork at officeLocal area3 days per week- ...an alternative application process. A/R Specialist Admin Professional Irvine, CA, Irvine, CA... ...ID: 1000 Responsibilities Analyze and review lease documents for the purpose of billing... ...all customer maintenance records and utilize LeaseWave to enter comments and to document...Contract workInterim role
- ...Behavior Intervention Specialist Under the supervision of the Family Care Coordinator,... ...initial and annual assessment/evaluation reviews, annual clinical trainings, behavior support... ..., unplanned and planned contingencies) utilizing baseline procedures and formulating a...Part timeWork at office
- ...Methodist, the Release of Information (ROI) Specialist position is responsible for responding... ...also ensures requests are addressed utilizing excellent customer service skills in a timely... ....). QUALITY/SAFETY ESSENTIAL FUNCTIONS Reviews incoming assigned requests for patient...
- ...is looking for a Quantitative Analytics Specialist in Charlotte, NC (Hybrid). Work with the... ...scale planning for Quantitative Analytics Review and analyze complex multi-faceted,... ...teams to transition them into production. Utilize generative AI development tools (e.g., Copilot...Long term contractContract work
$60k
...SCOPE OF ROLE : The Harm Reduction Specialist provides engagement and support... ...goals of program participants, including reviewing service plans with program participants... ...unsanitary conditions and safety hazards, utilizing individualized strategies, e.g. teaching...Local areaFlexible hoursWeekend workAfternoon shift
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