Utilization Review Specialist

2 days ago


Nyack, New York, United States Nyack Hospital Full time
Job Summary

The Utilization Review Specialist plays a critical role in ensuring that patients receive the most appropriate and efficient care possible. This position requires a strong understanding of healthcare systems and the ability to collaborate with healthcare teams to coordinate care delivery.

Key Responsibilities
  • Collaborate with healthcare teams to plan and coordinate patient care
  • Identify and address system variations and service delivery barriers that impact patient outcomes
  • Perform utilization management activities, including follow-up on denial claims and communication with managed care carriers
  • Facilitate assignment of level of care and respond to payer requirements to avoid adverse financial consequences
  • Provide superior customer service and model the We Care Standards
Requirements
  • Bachelor's Degree in Nursing
  • Three to five years of relevant clinical medical surgical, ICU or ER experience
  • HC-PRI certification and PRI screen preferred
  • Current NYS RN license required

The ideal candidate will possess effective written and verbal communication skills, decision-making and problem-solving skills, and insurance carrier comprehensive assessment skills. They must be detail-oriented and comfortable with investigating outcomes and communicating with physicians, physician extenders, and managed care systems over the phone and online.


  • Registered Nurse

    3 weeks ago


    Nyack, New York, United States Nyack Hospital Full time

    Job SummaryWe are seeking a highly skilled Registered Nurse to join our team at Nyack Hospital. As a critical care specialist, you will be responsible for providing high-quality patient care in our PACU department.Key ResponsibilitiesManage and coordinate patient care through effective communication with patients, families, and the healthcare team.Utilize...


  • Nyack, New York, United States The Ladders Full time

    Job Overview As a Senior Finance Specialist, you will play a pivotal role in overseeing monthly management and quarterly financial reporting for our organization. This includes consolidating reports for our parent company and ensuring accuracy at the entity level. Key ResponsibilitiesManage corporate tax calculations and estimated tax payments for the entire...


  • Nyack, New York, United States Eric Jaslow - State Farm Agent Full time

    Job OpportunityEric Jaslow - State Farm Agent is seeking a qualified and empathetic professional for the role of Life Insurance Specialist.Job SummaryThis is a customer-oriented position that requires marketing the best Life insurance services and products to benefit clients and their families.Key ResponsibilitiesEstablish Customer Relationships: Develop and...


  • Nyack, New York, United States Audi Nyack Full time

    Join our dynamic team as an Automotive Service Specialist! At Audi Nyack, we are committed to fostering your professional development and success. Our well-established service center is equipped with cutting-edge tools and technology specifically designed for Audi vehicles. We pride ourselves on providing a supportive environment that encourages growth and...


  • Nyack, New York, United States Nyack Hospital Full time

    At Nyack Hospital, we are dedicated to providing exceptional healthcare services with a focus on community well-being. Our commitment to quality care mirrors that of a leading academic medical institution while fostering a supportive environment for our staff. Our Benefits Include:Retirement savings plan with matching contributionsComprehensive medical,...

  • Contract Specialist

    2 weeks ago


    West Nyack, New York, United States The Salvation Army Eastern Territory Full time

    {"title": "Contract Specialist", "content": "Job SummaryThe Salvation Army Eastern Territory is seeking a highly skilled Contract Specialist to join our team. As a Contract Specialist, you will be responsible for reviewing and analyzing legal documents to ensure compliance with regulatory requirements and The Salvation Army's mission, program guidelines, and...


  • Nyack, New York, United States Nyack Hospital Full time

    At Nyack Hospital, we are dedicated to providing exceptional healthcare services while ensuring the well-being of our community and our employees. Our Benefits Include:Retirement savings plan with matching contributionsComprehensive medical, dental, and vision coverageTuition assistance for professional developmentGenerous Paid Time Off, including 8...

  • OCI Architect

    2 days ago


    Nyack, New York, United States LTIMindtree Full time

    About UsLTIMindtree is a global technology consulting and digital solutions company that enables enterprises across industries to reimagine business models, accelerate innovation, and maximize growth by harnessing digital technologies. As a digital transformation partner to more than 700+ clients, LTIMindtree brings extensive domain and technology expertise...


  • West Nyack, New York, United States Pepper Full time

    Position OverviewAbout Us:Pepper is an innovative enterprise focused on revolutionizing the mobile payment landscape. Our unique strategy and collaborations with leading national retailers empower users to earn rewards with every transaction, enhancing the overall value of their everyday purchases. Central to our mission is a dedication to a consumer-centric...


  • Nyack, New York, United States Nyack Hospital Full time

    About the RoleWe are seeking a highly skilled Care Management Specialist - Orthopedic Care Coordinator to join our team at Nyack Hospital. As a key member of our care coordination team, you will play a vital role in ensuring the seamless transition of care for our patients.Key ResponsibilitiesUtilize the nursing process to provide optimal quality and...


  • Nyack, New York, United States CSG Full time

    Structural Engineer Role at CSG **Job Summary** CSG is seeking a skilled Structural Engineer to join our team. As a Structural Engineer, you will be responsible for preparing formal calculation reports for design confirmation submissions to clients. **Key Responsibilities** * Prepare calculation packages for submission to clients * Draft structural...


  • West Nyack, New York, United States MedChi, The Maryland State Medical Society Full time

    Position Overview:MedChi, The Maryland State Medical Society, is in search of a dedicated E.N.T. Specialist/Otolaryngologist to enhance our healthcare offerings. We are committed to transforming healthcare delivery while ensuring a supportive environment for our clinicians.Why Choose MedChi?At MedChi, we prioritize a clinician-led approach that emphasizes...


  • West Nyack, New York, United States UnitedHealth Group Full time

    Physician - Internal Medicine Specialist OpportunityCare for patients with a range of medical conditions, from chronic diseases to acute illnesses, in a collaborative environment that prioritizes quality over quantity.Key Responsibilities:Direct and manage a complete continuum of high-quality care within the care teamTreat chronic diseases and...


  • Nyack, New York, United States Tandym Group Full time

    Position Overview:A prominent health services organization is seeking a dedicated professional to join their team as a Quality Coordinator. This role is essential in ensuring the enhancement of medical record documentation across both inpatient and outpatient settings.Key Responsibilities:The Quality Coordinator will be tasked with:1. Promoting the...


  • Nyack, New York, United States WMC Health Network Full time

    Job SummaryThe Senior Patient Service Representative provides on-site leadership for daily operations in a medical secretary setting. As a liaison between practitioners and patients, this role coordinates the delivery of care and services. Key responsibilities include assisting patients with check-in and check-out processes, educating patients on post-care...


  • Nyack, New York, United States Nyack Hospital Full time

    About the RoleWe are seeking a highly skilled and compassionate Registered Nurse to join our team in the Psychiatric Emergency Department at Nyack Hospital. As a key member of our multidisciplinary healthcare team, you will be responsible for providing high-quality patient care and contributing to a positive and supportive work...


  • West Nyack, New York, United States Optum Full time

    Diagnostic Imaging SpecialistOptum is seeking a skilled Diagnostic Imaging Specialist to join our team in the Tri-State region. As a Diagnostic Imaging Specialist, you will play a critical role in providing high-quality diagnostic imaging services to our patients.Key Responsibilities:Perform diagnostic imaging procedures, including X-rays, to diagnose or...


  • West Nyack, New York, United States Optum Full time

    Diagnostic Imaging SpecialistOptum is seeking a skilled Diagnostic Imaging Specialist to join our team in the Tri-State region. As a Diagnostic Imaging Specialist, you will play a critical role in providing high-quality diagnostic imaging services to our patients.Key Responsibilities:Perform diagnostic imaging procedures, including X-rays, to help diagnose...


  • West Nyack, New York, United States Optum Full time

    Diagnostic Imaging SpecialistOptum is seeking a skilled Diagnostic Imaging Specialist to join our team in the Tri-State region. As a Diagnostic Imaging Specialist, you will play a critical role in providing high-quality diagnostic imaging services to our patients.Key Responsibilities:Perform diagnostic imaging procedures, including X-rays, to diagnose or...


  • West Nyack, New York, United States Optum Full time

    Diagnostic Imaging SpecialistAt Optum, we're committed to helping people live healthier lives and making the health system work better for everyone.We're seeking a skilled Diagnostic Imaging Specialist to join our team in the Tri-State region. As a Diagnostic Imaging Specialist, you'll play a critical role in delivering high-quality patient care and...