Utilization Review Specialist

4 weeks ago


Lawrence, United States Lawrence General Hospital Full time

The Utilization Review Specialist, under supervision and in collaboration with the Utilization Review Coordinator, Utilization Review Nurses, Physician advisor and healthcare team supports all administrative tasks/responsibilities for utilization management and revenue integrity cycle processes. Interacts directly and indirectly with internal and external providers to review and monitor members# utilization of health care services with the goal of maintaining high-quality cost-effective care. The URS works collaboratively with utilization management staff to obtain information from clinical reviews and medical records to provide the appropriate communication for authorization of medical services and procedures. The URS is an integral member of the health care team as well as the integrated care team and supports the case management/utilization review team on system-wide quality improvement/performance improvement initiatives. Perform other duties as needed and assigned by your supervisor. # REQUIRED EDUCATION AND EXPERIENCE: #####Bachelor#s Degree# #####1-2 year case management and utilization review experience in an acute care setting #####Knowledge and understanding of medical terminology #####Strong organizational skills# #####Flexibility and accountability# #####Demonstrated verbal, written skills# #####Interpersonal skills required# #####Critical thinking and knowledge of regulatory standards and reimbursement requirements# #####Computer skills required Lawrence General Hospital is a private, non-profit community hospital providing the Merrimack Valley # southern New Hampshire regions with patient-centered, compassionate, and quality health care for the whole family. For over 140 years, the dedicated doctors, nurses, and staff of Lawrence General have been committed to improving the health of the people and communities we serve. We are an Equal Opportunity Employer committed to hiring a diverse workforce.

The Utilization Review Specialist, under supervision and in collaboration with the Utilization Review Coordinator, Utilization Review Nurses, Physician advisor and healthcare team supports all administrative tasks/responsibilities for utilization management and revenue integrity cycle processes. Interacts directly and indirectly with internal and external providers to review and monitor members' utilization of health care services with the goal of maintaining high-quality cost-effective care. The URS works collaboratively with utilization management staff to obtain information from clinical reviews and medical records to provide the appropriate communication for authorization of medical services and procedures. The URS is an integral member of the health care team as well as the integrated care team and supports the case management/utilization review team on system-wide quality improvement/performance improvement initiatives. Perform other duties as needed and assigned by your supervisor.

REQUIRED EDUCATION AND EXPERIENCE:

* Bachelor's Degree
* 1-2 year case management and utilization review experience in an acute care setting
* Knowledge and understanding of medical terminology
* Strong organizational skills
* Flexibility and accountability
* Demonstrated verbal, written skills
* Interpersonal skills required
* Critical thinking and knowledge of regulatory standards and reimbursement requirements
* Computer skills required

Lawrence General Hospital is a private, non-profit community hospital providing the Merrimack Valley & southern New Hampshire regions with patient-centered, compassionate, and quality health care for the whole family. For over 140 years, the dedicated doctors, nurses, and staff of Lawrence General have been committed to improving the health of the people and communities we serve.

We are an Equal Opportunity Employer committed to hiring a diverse workforce.



  • Lawrence, United States KU The University Of Kansas Full time

    26017BR Ambler Rec Weight Room Specialist Recreation Services Job Description Weight Room Specialists are responsible for the daily operations of the Cardiovascular/Resistance Training (CRT) areas at Ambler Student Recreation Fitness Center including but not limited to providing a safe exercise environment; assisting patrons; enforcing...

  • Server

    1 week ago


    Lawrence Township, United States Senior Living Recruiting Specialist Full time

    Great Entry position into Senior Living! Are you an experienced Server that is looking for stability, an opportunity for career growth and great benefits?? If you answered yes, this job may be for you.? Our client is seeking Servers that have a deep passion for the residents they serve, and a company they can call home and continue to grow in their...


  • Lawrence, United States Lawrence General Hospital Full time

    Case Management Resources Specialist Works collaboratively with the Complex Care Nurse Managers, Social Workers, and Utilization Review Nurses, in coordinating and providing care that is safe, timely, effective, efficient, equitable and client-centered. Assuming all administrative responsibilities within the admission and discharge planning, Perform other...


  • Lawrence, United States Heartland Community Health Center Full time

    Job DescriptionJob DescriptionSalary: $17.00 - $21.00Welcoming all who need care Job title Community Health Worker - Insurance Enrollment Specialist (IES)Reports to Director of Patient EngagementStatus Non-Exempt (Hourly) Job purpose The Insurance Enrollment Specialist (IES) plays a crucial role in the healthcare system. The primary responsibility is...


  • Lawrence, Kansas, United States The Oread Hotel Full time

    We are looking for people that have a passion to serve others Working at the front desk means you are at the hub of the hotel with the most interaction with our guests. The department is open each front desk role is as important as the others. Associates working the front desk are the key to the overall experience the guest will have. As the late shift you...


  • Lawrence, Kansas, United States University of Kansas Full time

    26776BRSSC Finance Position OverviewThe Shared Service Centers Finance at the University of Kansas is searching for multiple Accounting Specialist positions. The day-to-day finance activities in the SSC will be conducted by Accountants and Accounting Specialists. These positions will be responsible for working with assigned units, departments and centers as...

  • Benefits Specialist

    1 month ago


    Lawrence, United States AgeSpan Full time

    **AgeSpan** - Formerly Elder Services of the Merrimack Valley/North Shore_ **About Us**:Since 1974 our agency has strived towards supporting an individual's desire to make their own decisions, secure their independence and remain living independently in the community. We are proud of our employees who make this possible every day. Our agency is a...


  • Lawrence, United States Ethos Veterinary Health Full time

    $1,000 SIGN ON BONUS! Are you a highly motivated individual with a passion for delivering exemplary client service? Bulger Veterinary Hospital in Lawrence, MA, is currently seeking a full-time Client Care Specialist to join our dedicated team. About Us: At Bulger, we pride ourselves on providing comprehensive care, including General Practice, 24-hour...


  • Lawrence, United States ProPivotal Full time

    Behavioral Support Specialist ($25/hr) Are you passionate about making a difference in the lives of others? We are seeking a dedicated Behavioral Support Specialist to join our team. This rewarding role offers competitive compensation at $25 per hour and an opportunity to positively impact individuals in need of behavioral support. What we are looking...


  • Lawrence, United States ProPivotal Full time

    Behavioral Support Specialist ($25/hr) Are you passionate about making a difference in the lives of others? We are seeking a dedicated Behavioral Support Specialist to join our team. This rewarding role offers competitive compensation at $25 per hour and an opportunity to positively impact individuals in need of behavioral support.What we are looking...


  • Lawrence, Kansas, United States General Dynamics Information Technology Full time

    Req ID: RQ176111Type of Requisition: RegularClearance Level Must Be Able to Obtain: NonePublic Trust/Other Required: MBI Full 5C (T3)Job Family: Customer ServiceSkills:Call Center,Customer Satisfaction,Customer Service,Microsoft Outlook,Telephone CommunicationsExperience:1 + years of related experienceUS Citizenship Required:YesJob Description:Customer...


  • Lawrence, United States Jeo Consulting Group Full time

    Company Overview JEO is not your typical engineering firm. We have a welcoming, fun, and laid-back culture that encourages communication and collaboration where our greatest strength is our team members. If you value great work-life integration and work best in a relaxed, supportive, and inclusive environment, we may be the place where you ARE the best...


  • Lawrence, United States General Dynamics Information Technology Full time

    Req ID: RQ176111 Type of Requisition: Regular Clearance Level Must Be Able to Obtain: None Public Trust/Other Required: MBI Full 5C (T3) Job Family: Customer Service Skills: Call Center,Customer Satisfaction,Customer Service,Microsoft Outlook,Telephone Communications Experience: 1 + years of related experience US Citizenship...


  • Lawrence, United States HonorVet Technologies Full time

    Indirect Sourcing Specialist Duration: 6+ months with a sure possibility of Extension Location: Lawrence, KS 66044 (Hybrid role) Shift: 1 st shift Monday-Friday Job Description Responsibilities include: Assist the travel and expense leadership with identification and implementation of process improvement initiatives, system enhancements,...


  • Lawrence, United States Ethos Veterinary Health Full time

    $1,000 SIGN ON BONUS! Are you a highly motivated individual with a passion for delivering exemplary client service? Bulger Veterinary Hospital in Lawrence, MA, is currently seeking a full-time Client Care Specialist to join our dedicated team. About Us: At Bulger, we pride ourselves on providing comprehensive care, including General Practice, 24-hour...

  • Benefits Specialist

    4 weeks ago


    Lawrence, United States AgeSpan Inc Full time

    AgeSpan Formerly Elder Services of the Merrimack Valley/North Shore About Us: Since 1974 our agency has strived towards supporting an individual's desire to make their own decisions, secure their independence and remain living independently in the community. We are proud of our employees who make this possible every day. Our agency is a thought-leader, a...


  • Lawrence, United States Northeast Family Services Full time

    Job DescriptionJob DescriptionNortheast Family Services is seeking an experienced masters-level professional to join our growing Massachusetts CBHI team as an Intake Screener and Authorization Specialist! The Intake Screener and Authorization Specialist manages all aspects of the registration and admissions process for Northeast Family Services’ five...

  • Benefits Specialist

    1 month ago


    Lawrence, United States AgeSpan Full time

    Job DescriptionJob DescriptionAgeSpanFormerly Elder Services of the Merrimack Valley/North ShoreAbout Us: Since 1974 our agency has strived towards supporting an individual's desire to make their own decisions, secure their independence and remain living independently in the community. We are proud of our employees who make this possible every day. Our...


  • Lawrence, United States Greater Lawrence Family Health Center Full time

    Established in 1980, the Greater Lawrence Family Health Center (GLFHC) is a multi-site mission-driven non-profit organization employing over 700 staff whose primary focus is providing the highest quality patient care to residents throughout the Merrimack Valley. Nationally recognized as a leader in community medicine (family practice, pediatrics, internal...


  • Lawrence, United States Mentor South Bay Full time

    ** $3000 New Hire Bonus** **Early Intervention Specialist**: Raising a child with a developmental disability is a journey that takes knowledge, love, patience, and support. You will be part of a team that provides in-home early intervention specialized services for infants and toddlers where they can naturally learn and develop. - Plan, schedule and provide...