We have other current jobs related to this field that you can find below
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Healthcare Utilization Review Specialist
8 hours ago
New York, New York, United States VNS Health Full timeAbout the JobVNS Health is seeking a skilled healthcare professional to lead interdepartmental quality improvement activities, focusing on clinical review, risk management, and patient satisfaction.Key ResponsibilitiesConduct thorough clinical assessments, including medication reconciliations, post-discharge transitions of care, and follow-up...
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Utilization Review Coordinator
2 days ago
New York, New York, United States StateJobsNY Full timeJob SummaryWe are seeking a highly skilled Utilization Review Coordinator to join our team at StateJobsNY. As a key member of our healthcare operations team, you will be responsible for analyzing and evaluating the quality, effectiveness, and efficiency of psychiatric and medical services provided to individuals diagnosed with mental illness.Key...
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Utilization Review Coordinator
13 hours ago
New York, New York, United States StateJobsNY Full timeJob SummaryWe are seeking a highly skilled Utilization Review Coordinator to join our team at StateJobsNY. As a key member of our healthcare operations team, you will play a critical role in analyzing and evaluating the quality, effectiveness, and efficiency of psychiatric and medical services provided to individuals diagnosed with mental illness.Key...
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Utilization Review Coordinator
13 hours ago
New York, New York, United States StateJobsNY Full timeJob SummaryWe are seeking a highly skilled Utilization Review Coordinator to join our team at StateJobsNY. As a key member of our healthcare operations team, you will play a critical role in analyzing and evaluating the quality, effectiveness, and efficiency of psychiatric and medical services provided to individuals diagnosed with mental illness.Key...
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RN Utilization Review
4 weeks ago
New York, New York, United States V R Della IT Services Private Limited Full time## Job OverviewWe are seeking a dedicated Utilization Review Nurse to join our healthcare team. The ideal candidate will be responsible for reviewing medical records to ensure that patients receive necessary care and treatment while optimizing healthcare resources.-*Job Description**Initial and concurrent Status Reviews, MDR's, Denial work.*Requirements**RN...
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Utilization Management Reviewer
1 month ago
New York, New York, United States tapwage Full timeJob Description:Summary:This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ensuring compliance with internal and external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and...
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Utilization Review Nurse
4 weeks ago
New York, United States Village Care Full timeJob DescriptionJob DescriptionRN- Utilization Review Nurse LTSS*Full Time 100% Remote Opportunity*COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGECARE!VillageCare is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from the comfort of your own home as...
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Utility Meter Specialist
5 days ago
New York County, New York, United States Veolia Full timeJob OverviewCompensation:Hourly wage ranging from $25.00 to $30.00EMPLOYEE BENEFITSVeolia offers a robust benefits package that includes paid time off, health, dental, and vision insurance. Employees can also participate in a company-sponsored 401(k) plan to prepare for retirement. For union-represented employees, pay and benefits are defined in their...
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Facilities Utility Specialist
2 months ago
New York, New York, United States United Airlines Full timeKey Responsibilities:As a Facilities Utility Specialist you will work in a fast-paced Facilities Maintenance Operations department. The Facilities Utility Specialist plays a very important role in providing quality service to our internal customers. The Facilities Utility Specialist performs work in accordance with guidelines established in the collective...
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Senior Credit Review Specialist
6 days ago
New York, New York, United States Crédit Agricole CIB Limited Full timeVacancy OverviewCompany BackgroundEntity Crédit Agricole Corporate and Investment Bank (Crédit Agricole CIB) is a leading player in the corporate and investment banking sector, part of the Crédit Agricole Group, one of the largest banking groups globally by balance sheet size. With a workforce of approximately 8,600 professionals across more than 30...
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Utilization Review Physician
3 months ago
New York, United States Vivo HealthStaff Full timeJob DescriptionJob DescriptionVivo HealthStaff is recruiting for a Utilization Review Physician based in New York for a Managed Care Insurance Plan. This position requires 4 days per month on-site.The Utilization Review Physician is the lead clinician for the health plan. Responsible for the administration of medical services for company health plan...
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Utilization Review/Management Coordinator
2 months ago
New York, United States NYC Health Hospitals Full timeWoodhull Medical and Mental Health Center is attuned to the healthcare issues that matter to the people of North Brooklyn. Woodhull focuses on preventing disease and promoting healthy lifestyles by reaching out to the community at various locations. At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception....
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Utilization Review Case Manager
3 months ago
New Canaan, United States Silver Hill Hospital Full timeJob DescriptionJob DescriptionUtilization Review Case ManagerThe UR Case Manager will complete prior authorizations and concurrent reviews for new admissions or existing patients. The UR Case Manger will work with insurance companies and the clinical team, reviewing documentation to determine medical necessity criteria and length of...
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Utilization Review Manager
3 days ago
New Baltimore, United States Harbor Oaks Hospital Full timeOverview:Harbor Oaks Hospital is looking for a PRN - Utilization Review Manager to join our team!Harbor Oaks Hospital, New Baltimore's leading Mental Health and Addiction Treatment Center is seeking a passionate Utilization Review Manager to work at our facility in New Baltimore, MI.Non-Exempt PositionMonday - Friday - Day Shift (2 days per week)Rate of Pay:...
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Utilities Operations Specialist
6 days ago
New York, New York, United States Upward Full timeAbout the RoleWe are seeking a Utilities Operations Specialist to join our dynamic team at Upward. This position is ideal for an individual with a strong background in utility analysis, particularly within the realm of property management. The successful candidate will have a minimum of 3 years of relevant experience and will play a crucial role in...
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Utilities Operations Specialist
4 weeks ago
New York, New York, United States tapwage Full timeAt DuPont, we are working on things that matter; whether it's providing clean water to more than a billion people on the planet, producing materials that are essential in everyday technology devices from smartphones to electric vehicles, or protecting workers around the world.If you would like to be a part of a premier multi-industrial company that is...
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Operations Utility Specialist
2 days ago
New York, New York, United States Doyle Shamrock Industries Full timePosition Overview:We are seeking a dedicated and skilled Operations Utility Specialist to join our team at Doyle Shamrock Industries. This role is essential in ensuring smooth operations within our facility.Key Responsibilities:Consistently lift weights ranging from 30lbs to 75lbs.Flexibility to work various shifts, including first, second, or...
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Utility Cost Management Specialist
6 days ago
New York, New York, United States FirstService Residential New York Full timePosition Summary: The Energy Procurement Specialist plays a pivotal role in collaborating with various stakeholders to enhance the service offerings of FirstService Residential. Reporting directly to the Director of Procurement, this position aims to further develop the existing energy management program tailored for residential buildings. The specialist...
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Acount Review Specialist
4 weeks ago
York, United States Cornerstone Bank Full timeJob DescriptionJob DescriptionThe Account Review Specialist is a non-customer facing position. Employees in this position excel at attention to detail and working in an office environment that provides the opportunity to learn the details of banking products. Position is in a secure office space not located in Main Bank. JOB DUTIESPrimary duties include...
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Utilization Review Nurse
3 months ago
43 New Scotland Avenue Albany, NY 12208, United States Albany Medical Center Full time43 New Scotland Avenue Albany, NY 12208Department/Unit:Care Management/Social WorkWork Shift:Day (United States of America)Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients.Salary Range: $31.28 - $51.61 per hour• Completes Utilization Management and Quality Screening for assigned patients.• Applies MCG...
Utilization Review Specialist
2 months ago
Zinnia Health is a fast-growing integrated healthcare company. We value our employees and care for our clients. Do you have unique talents that you would like to share with others? We would love to have you join our team
- Competitive Pay
- Career Development
- Competitive Benefits & 401k
- Values: Integrity, Teamplay, 1% Better Each Day
We are seeking a Utilization Review Specialist that has experience with medical record auditing in the substance abuse treatment field. The Utilization Review Specialist is responsible for managing the review process for client services to ensure the appropriate utilization of resources within a substance abuse treatment facility. This role involves evaluating patient treatment plans, ensuring compliance with healthcare regulations, and working closely with clinical staff to optimize patient care while maintaining cost-effectiveness.
RESPONSIBILITIES
Review and Evaluation:
- Conduct thorough reviews of patient treatment plans and medical records to ensure services meet clinical guidelines and regulatory requirements.
- Evaluate the necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities.
Authorization and Documentation:
- Obtain necessary pre-authorizations and ongoing authorizations for treatment services from insurance companies and other payers.
- Document and maintain detailed records of reviews, decisions, and communications with healthcare providers and payers.
Compliance and Regulation:
- Ensure compliance with all federal, state, and local regulations, including HIPAA and other confidentiality standards.
- Stay current with changes in healthcare regulations and payer requirements.
Collaboration and Communication:
- Work closely with clinical staff to ensure treatment plans are appropriate and adjusted as needed.
- Communicate effectively with insurance companies, third-party payers, and other external entities to advocate for patient care needs.
- Provide education and training to clinical staff on utilization review processes and best practices.
- Assist in developing and implementing policies and procedures related to utilization review.
QUALIFICATIONS
- Minimum high school diploma/GED. Bachelor's degree in social work, health administration, or a related field preferred.
- Minimum of 1 year of experience in the field
- Strong analytical and critical thinking skills.
- Excellent communication and interpersonal skills.
- Proficiency in healthcare software and electronic health records (EHR) systems.
- Ability to work independently and as part of a multidisciplinary team.
- Knowledge of substance abuse treatment modalities and practices.
