Healthcare Utilization Review Specialist

3 days ago


Prescott, Arizona, United States Medusind Full time
About the Role

Medusind is seeking a skilled Healthcare Utilization Review Specialist to join our team. As a key member of our Utilization Review Team, you will play a critical role in advocating for patient care at substance abuse treatment facilities by obtaining insurance authorizations for all levels of care.

Key Responsibilities
  • Obtain treatment authorizations from health insurance companies
  • Maintain accurate and timely documentation
  • Function as a member of the Utilization Review Team to ensure that all daily responsibilities are met
  • Develop collaborative partnership relationships with insurance care managers and healthcare providers to provide clients with expeditious delivery of service
  • Ongoing communication with healthcare providers and support staff through frequent communication and interactions
  • Respond to insurance denials through the written appeals process when appropriate
  • File retrospective reviews as needed
  • Participate in continuing professional education
  • Perform other duties as assigned or required as part of the UR team
Competencies
  • Demonstrate ability to independently identify and define potential and/or current issues of concern, collect and analyze data, establish facts, draw valid conclusions, and exercise discretion and sound judgment
  • Demonstrate written and oral communication skills to formulate business correspondence and convey complex medical and behavioral health information
Qualifications
  • Knowledge of medical and behavioral health terminology, physiology, concepts of disease and treatment methodologies
  • Knowledge in reviewing medical and behavioral health records for medical necessity
  • Skill in operating a personal computer utilizing a variety of software applications
  • Organized and able to meet deadlines consistently
  • Excellent customer service skills
  • Strong knowledge base surrounding substance abuse and mental health conditions and treatment
About Medusind

Since 2002, organizations across the entire healthcare spectrum have leveraged our deep expertise and high-quality solutions to maximize revenue, reduce operating costs, and navigate the changing healthcare landscape. Medusind's unique combination of deep industry expertise, robust operational capability, and client-focused service significantly improves the efficiency and profitability of healthcare organizations. Client satisfaction is the primary focus of the Medusind leadership and staff. Our highly experienced personnel, cutting-edge technology, and forward-thinking approach allow us to deliver effective solutions while staying ahead of healthcare industry changes.



  • Prescott, Arizona, United States TTF Full time

    Healthcare Support Specialist Job OverviewWe are looking for dedicated Healthcare Support Specialists to join a prominent healthcare organization.Positions available for both administrative and clinical roles.A minimum of 2 years of relevant experience is essential.Successful completion of a background check is required.Candidates should demonstrate a...

  • Physician Advisor

    3 days ago


    Prescott, Arizona, United States Dignity Health Full time

    About the RoleThe Physician Advisor plays a critical role in promoting evidence-based standards of medical care while maintaining appropriate utilization of hospital resources. This position is responsible for facilitating communication between the Department of Care Coordination, Medical Staff, Nursing Staff, and Administration regarding systems-based...


  • Prescott, Arizona, United States Dignity Health Full time

    OverviewAt Dignity Health, our commitment to our values translates into dedicated action every day. As a key part of our healthcare network, we provide a comprehensive range of inpatient and outpatient services, ensuring ample opportunities for career advancement.Dignity Health operates as a not-for-profit integrated healthcare provider, encompassing two...


  • Prescott, Arizona, United States Cephas Consultancy Services Private Limited Full time

    Seeking a Committed Healthcare Compliance SpecialistCephas Consultancy Services Private Limited is in search of a passionate healthcare compliance specialist to enhance our team dedicated to delivering exceptional care to our clients and patients. The successful candidate will demonstrate a robust dedication to regulatory adherence and excellence in...

  • Physician Advisor

    2 weeks ago


    Prescott, Arizona, United States Dignity Health Full time

    About the RoleWe are seeking a highly skilled Physician Advisor to join our team at Dignity Health. As a key member of our clinical leadership team, you will play a critical role in promoting evidence-based standards of medical care while maintaining appropriate utilization of hospital resources.Key ResponsibilitiesFacilitate Communication: Collaborate with...


  • Prescott, Arizona, United States Dignity Health Full time

    OverviewAt Dignity Health, embodying our values translates into a daily commitment to excellence. As a not-for-profit integrated healthcare provider, Dignity Health-Yavapai Regional Medical Center (DH-YRMC), now part of CommonSpirit Health, offers a comprehensive array of inpatient and outpatient services, alongside numerous opportunities for career...


  • Prescott, Arizona, United States TTF Full time

    Job OverviewTTF Healthcare is seeking qualified Healthcare Support Specialists for a reputable specialty practice. These positions are direct-hire opportunities that provide a competitive salary and excellent benefits, along with opportunities for professional growth within a dynamic organization.Key ResponsibilitiesThe role involves a variety of essential...


  • Prescott, Arizona, United States Exceptional Healthcare Inc. Full time

    Clinical Respiratory Specialist Opportunity at Exceptional Healthcare Inc.Exceptional Healthcare Inc. is actively seeking a Clinical Respiratory Specialist to become a vital member of our dedicated team.We are looking for candidates who meet the following criteria:Valid Respiratory Therapist license with a minimum of 2 years of experience in emergency and...

  • Travel Nurse RN

    5 days ago


    Prescott, Arizona, United States IDR Healthcare Full time

    Job SummaryIDR Healthcare is seeking a skilled Travel Nurse RN to join our team as a Telemetry Specialist. This is a 13-week assignment with a 36-hour workweek, offering a unique opportunity to work in a dynamic healthcare environment.Key ResponsibilitiesProvide high-quality patient care as a Telemetry Specialist, utilizing advanced clinical skills and...


  • Prescott, Arizona, United States Cross Country Healthcare Full time

    Job SummaryCross Country Healthcare is seeking a skilled Travel Nurse RN Telemetry Specialist to provide high-quality patient care in a dynamic healthcare environment.Key ResponsibilitiesDeliver exceptional patient care to patients requiring cardiac monitoring and frequent vital sign assessments.Collaborate with interdisciplinary teams to develop and...

  • Medical Director

    2 weeks ago


    Prescott, Arizona, United States Dignity Health Full time

    About the RoleWe are seeking a highly skilled Physician Advisor to join our team at Dignity Health. As a key member of our clinical leadership team, you will play a critical role in promoting evidence-based standards of medical care while maintaining appropriate utilization of hospital resources.Key ResponsibilitiesUtilization Management: Provide valid and...


  • Prescott, Arizona, United States Medusind Full time

    {"Job Title": "Payment Processing Specialist", "Job Description": "Job SummaryMedusind is seeking a highly skilled Payment Processing Specialist to join our team. As a Payment Processing Specialist, you will be responsible for reviewing and processing incoming insurance payments, identifying and correcting posting errors, and ensuring accurate payment...


  • Prescott, Arizona, United States SkyBridge Healthcare Full time

    Job Title: Travel Nurse RN SpecialistJob Summary:SkyBridge Healthcare is seeking a skilled Travel Nurse RN Specialist to join our team. As a Travel Nurse RN Specialist, you will have the opportunity to work in a dynamic and challenging environment, providing high-quality patient care and contributing to the success of our healthcare organization.Job...

  • Travel Nurse RN

    1 week ago


    Prescott, Arizona, United States Genie Healthcare Full time

    Job Title: Travel Nurse RN - Telemetry SpecialistJob Summary:Genie Healthcare is seeking a skilled Travel Nurse RN - Telemetry Specialist to join our team. As a Travel Nurse RN - Telemetry Specialist, you will be responsible for providing high-quality patient care in a telemetry setting.Responsibilities:Provide direct patient care to patients in a telemetry...

  • Travel Nurse RN

    1 week ago


    Prescott, Arizona, United States Host Healthcare Full time

    Job Title: Travel Nurse RN - CVICU SpecialistJob Type: Travel NursingLocation: Prescott, ArizonaJob Description:Job Summary:Host Healthcare is seeking a skilled Travel Nurse RN - CVICU Specialist to join our team. As a Travel Nurse RN - CVICU Specialist, you will be responsible for providing high-quality patient care in a Cardiovascular Intensive Care Unit...

  • Travel Nurse RN

    3 days ago


    Prescott, Arizona, United States Host Healthcare Full time

    Job Title: Travel Nurse RN - CVICU SpecialistJob Type: Travel NursingLocation: Prescott, ArizonaJob Description:Job Summary:Host Healthcare is seeking a skilled Travel Nurse RN - CVICU Specialist to join our team. As a Travel Nurse RN - CVICU Specialist, you will be responsible for providing high-quality patient care in a Cardiovascular Intensive Care Unit...

  • Travel Nurse RN

    1 week ago


    Prescott, Arizona, United States Host Healthcare Full time

    Job DescriptionJob Title: Travel Nurse RN - ICU SpecialistJob Type: Travel NursingLocation: Prescott, ArizonaJob Description:We are seeking a highly skilled and experienced Travel Nurse RN - ICU Specialist to join our team at Host Healthcare. As a Travel Nurse RN - ICU Specialist, you will be responsible for providing high-quality patient care in a...


  • Prescott, Arizona, United States Host Healthcare Full time

    Job Opportunity: Host Healthcare is seeking an experienced Physical Therapist for a travel allied job in a dynamic healthcare setting.About the Job:Job Type: Travel Allied JobLocation: Prescott, AZDuration: 13 weeksPay: $2021.6 / WeekAbout Host Healthcare:At Host Healthcare, we are dedicated to empowering the life and healthcare career you deserve. As a...

  • Travel Nurse RN

    1 week ago


    Prescott, Arizona, United States Host Healthcare Full time

    Join Our Team as a Travel Nurse RN - Telemetry SpecialistAt Host Healthcare, we're committed to providing unparalleled service and ensuring a pleasant assignment experience for our travelers. As a Travel Nurse RN - Telemetry Specialist, you'll have the opportunity to work with a passionate and transparent team that's dedicated to helping you navigate every...


  • Prescott, Arizona, United States Host Healthcare Full time

    Job Title: Travel Nurse RN ICU SpecialistJob Type: Travel NursingLocation: Prescott, ArizonaJob Description:Host Healthcare is seeking a skilled Travel Nurse RN ICU Specialist to join our team. As a Travel Nurse RN ICU Specialist, you will be responsible for providing high-quality patient care in a fast-paced ICU environment.Responsibilities:Provide direct...