Utilization Review Specialist
2 weeks ago
ESSENTIAL FUNCTIONS: * Act as liaison between managed care organizations and the facility professional clinical staff. * Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements. * Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay. * Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office. * Conduct quality reviews for medical necessity and services provided. * Facilitate peer review calls between facility and external organizations. * Initiate and complete the formal appeal process for denied admissions or continued stay. * Assist the admissions department with pre-certifications of care. * Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates. OTHER FUNCTIONS: * Perform other functions and tasks as assigned. EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: * Associate's degree in nursing (LPN or RN) required. Bachelor's or Master's degree in social work, behavioral or mental health, nursing or other related health field preferred. * Two or more years' experience with the population of the facility and previous experience in utilization management preferred. LICENSES/DESIGNATIONS/CERTIFICATIONS: * Current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services. * CPR and de-escalation and restraint certification required (training available upon hire and offered by the facility.
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Utilization Review Supervisor
3 days ago
Chicago, United States COMPASS HEALTH CENTER, LLC. Full timeWe are seeking a Utilization Review Supervisor to lead a team of specialists in obtaining appropriate insurance authorization for our patients to receive Behavioral Health treatment at high levels of care. In addition to overseeing and providing direction to the team, the UR Supervisor must possess exemplary organizational skills, and have a clear passion in...
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Utilization Review Supervisor
5 days ago
Chicago, United States Compass Health Center Full timeWeekly outpatient therapy isn't always enough, and a trip to the ER isn't the only answer. Patients and their families rely on Compass Health Center when in crisis - every day, we help people overcome depression, anxiety, suicidality, obsessions/compulsions, trauma, chronic pain, and other obstacles in order for our patients to live freely. **About This...
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Utilization Reviewer/Trainer
2 weeks ago
Chicago, United States A Beautiful Mind Inc. Full timeJob DescriptionJob DescriptionAt A Beautiful Mind, Inc., our employees are driven by a deep sense of service, high standards of professionalism and a responsibility to better the public good. We are currently seeking an Utilization Reviewer/Trainer who has a passion for providing the highest quality care in an institutional, secure setting. Come join a team...
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Utilization Review Coordinator
Found in: Lensa US P 2 C2 - 1 week ago
Chicago, United States Page Mechanical Group Inc Full timeUtilization Review Coordinator-RN La Rabida Childrens Hospital is hiring a Utilization Review Coordinator - RN for the Case ManagementDepartment in Chicago, IL. This position works hybrid three (3) days per week! La Rabida offers rewarding job opportunities across a wide array of clinical, administrative, and support service functions. If youre ready to...
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Utilization Review Coordinator
Found in: Lensa US P 2 C2 - 2 weeks ago
Chicago, United States Page Mechanical Group Inc Full timeUtilization Review Coordinator-RN La Rabida Children’s Hospital is hiring a Utilization Review Coordinator - RN for the Case ManagementDepartment in Chicago, IL. This position works hybrid three (3) days per week! La Rabida offers rewarding job opportunities across a wide array of clinical, administrative, and support service functions. If you’re ready...
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Utility & Transportation Specialist
3 days ago
Chicago, United States Heartland Alliance Full timeJob DescriptionJob DescriptionTitle: Utility & Transportation SpecialistLocation: Beverly, Chicago, ILSchedule: 6a - 2:30p and 10:30a - 7:00p. Summary: Are you passionate about making a difference and contributing to a greater cause? We have an exciting opportunity for a Utility & Transportation Specialist to join our dynamic team at Heartland Human Care...
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Utility & Transportation Specialist
3 days ago
Chicago, United States Heartland Human Care Services Full timeJob DescriptionJob DescriptionTitle: Utility & Transportation SpecialistSchedule: Tuesday - Saturday, 1st Shift (8a-4:30p) Location: Bronzeville Summary: Are you passionate about making a difference and contributing to a greater cause? We have an exciting opportunity for a Utility & Transportation Specialist to join our dynamic team at Heartland Human Care...
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Utility & Transportation Specialist
2 weeks ago
Chicago, United States Heartland Human Care Services Full timeJob DescriptionJob DescriptionTitle: Utility & Transportation SpecialistSchedule: Tuesday - Saturday, 1st Shift (8a-4:30p) Location: Bronzeville Summary: Are you passionate about making a difference and contributing to a greater cause? We have an exciting opportunity for a Utility Worker to join our dynamic team at Heartland Human Care Services! As a Utility...
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Utility & Transportation Specialist
1 week ago
Chicago, United States Heartland Alliance Full timeJob DescriptionJob DescriptionTitle: Utility & Transportation SpecialistLocation: Beverly, Chicago, ILSchedule: 6a - 2:30p and 10:30a - 7:00p. Summary: Are you passionate about making a difference and contributing to a greater cause? We have an exciting opportunity for a Utility Worker to join our dynamic team at Heartland Human Care Services! As a Utility...
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Clean Utilities Engineer
2 weeks ago
Chicago, United States MMR Consulting Full timeJob DescriptionJob DescriptionSalary: MMR Consulting is an engineering and consulting firm specializing in the pharmaceutical, and biotechnology industries in the US and Canada. Its services include Engineering, Project Management, and other Consulting services. MMR’s Engineering expertise includes Process, Automation, Facilities engineering....
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Physician Reviewer
Found in: Jooble US O C2 - 2 weeks ago
Chicago, IL, United States Dane Street Full timeDane Street, a certified "Great Place to Work'' company, is searching for Board Certified Internal Medicine physicians to conduct Independent Medical Exams (IME) and Peer Reviews. This opportunity allows you to customize your schedule and caseload within a standard Monday - Friday work week while maintaining client-mandated turnaround times. We will...
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Utility Distribution Auditor
3 days ago
Chicago, United States CN Utility Consulting Full time**Title**: Utility Distribution Auditor **FLSA Status**: Non-Exempt **Reports To**: Regional Supervisor **Effective**: 03/2024 As our next Utility Distribution Auditor, you’re on your way to the open road and traveling the trails! We keep the lights on anywhere there’s a power line - whether in the city, the rural countryside, or deep in the remote...
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Contract Review Consultant
2 weeks ago
Chicago, United States J&M Business Solutions LLC Full timeJob DescriptionJob DescriptionJ&M Business Solutions LLC: Your Gateway to Direct Hire OpportunitiesWelcome to J&M Business Solutions LLC, your trusted partner in finding direct hire employment opportunities. As a one-woman recruitment act, I specialize in connecting talented individuals like you with reputable clients seeking permanent or contract direct...
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eDiscovery Document Review Attorney
Found in: Talent US C2 - 1 week ago
Chicago, United States Hire Counsel Full timeAs one of the nation’s largest legal staffing providers, Hire Counsel is registering candidates for upcoming document review projects with AmLaw 100 Firms, government agencies, and industry-leading technology companies. Hire Counsel is seeking licensed attorneys for a document review project in Oklahoma to work remotely from their home. ...
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eDiscovery Document Review Attorney
Found in: Talent US C2 - 22 hours ago
Chicago, United States Hire Counsel Full timeAs one of the nation’s largest legal staffing providers, Hire Counsel is registering candidates for upcoming document review projects with AmLaw 100 Firms, government agencies, and industry-leading technology companies. Hire Counsel is seeking licensed attorneys for a document review project in Illinois to work remotely from their home. ...
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Compliance Specialist
Found in: beBee S US - 2 weeks ago
Chicago, United States The Community Builders Inc. Full timeOverview: The Community Builders, Inc. (TCB) is a nationally recognized nonprofit developer, owner and manager of affordable and mixed-income residential and commercial properties. Founded in 1964, TCB has developed over 25,000 residential units as well as office and retail properties and owns or manages over 11,000 rental units nationally. TCB strategic...
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Manufacturing Document Specialist
Found in: Appcast US C2 - 2 weeks ago
Chicago, United States Medix™ Full timeThe Manufacturing Document Specialist will be responsible for activities involving compliance with applicable regulatory requirements and internal policies within the Manufacturing Group. ESSENTIAL DUTIES and RESPONSIBILITIES include the following. Other duties may be assigned.· Performs the compliance review and approval of all manufacturing batch...
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Compliance Specialist
1 week ago
Chicago, United States The Community Builders Inc. Full timeOverview: The Community Builders, Inc. (TCB) is a nationally recognized nonprofit developer, owner and manager of affordable and mixed-income residential and commercial properties. Founded in 1964, TCB has developed over 25,000 residential units as well as office and retail properties and owns or manages over 11,000 rental units nationally. TCB strategic...
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Sales Support Specialist
5 days ago
Chicago, United States Hueman PE Talent Solutions Full timeJob DescriptionJob DescriptionPoint C Health is hiring a Sales Support Specialist! Point C is seeking a Sales Support Specialist to join our dynamic team. The Sales Support Specialist will play a crucial role in assisting the sales team in preparing proposals and associated collateral to drive business growth. The ideal candidate will possess excellent...
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Contract Review Consultant
Found in: Resume Library US A2 - 1 week ago
Chicago, Illinois, United States J&M Business Solutions LLC Full timeJ&M Business Solutions LLC: Your Gateway to Direct Hire Opportunities Welcome to J&M Business Solutions LLC, your trusted partner in finding direct hire employment opportunities. As a one-woman recruitment act, I specialize in connecting talented individuals like you with reputable clients seeking permanent or contract direct hires. Unlike traditional...