Current jobs related to Healthcare Utilization Review Specialist - Delray Beach, Florida - Staffosaurus

  • Utilization Review Specialist

    1 month ago

    Delray Beach, Florida, United States Staffosaurus Full time

    About the JobCongress Billing is a leading Billing Management Company that prioritizes the best interests of its clients. Our mission is to provide a low-cost RCM solution that maximizes insurance reimbursements in the shortest time possible, while maintaining the highest level of professionalism, ethics, and transparency.Job SummaryThe Utilization Review...

  • Clinical Utilization Review Specialist

    2 weeks ago

    West Palm Beach, Florida, United States Centene Corporation Full time

    Job Title: Utilization Review Clinician - ABACentene Corporation is seeking a highly skilled Utilization Review Clinician - ABA to join our Medical Management/Health Services team. As a clinical professional, you will play a critical role in ensuring the medical appropriateness of Applied Behavioral Analysis (ABA) services provided to our 28 million...

  • Healthcare Payer Operations Specialist

    2 weeks ago

    Delray Beach, Florida, United States ClinDCast Full time

    Job Title: Healthcare Payer Operations SpecialistJob Summary: We are seeking a Healthcare Payer Operations Specialist with extensive experience in healthcare payer operations, particularly in the areas of Enrollment, Claims, and Billing. The ideal candidate will possess in-depth knowledge of the QNXT data model and its applications within healthcare payer...

  • Healthcare Specialist

    7 days ago

    Delray Beach, Florida, United States My Florida Corp Defunct Full time

    Job SummaryThe My Florida Corp Defunct is seeking a skilled Healthcare Specialist to join our team. As a Nurse Surveyor, you will be responsible for conducting inspections of healthcare facilities to ensure compliance with state and federal regulations.Key ResponsibilitiesConduct surveys of healthcare facilities to evaluate compliance with state and federal...

  • Healthcare Specialist

    1 week ago

    Delray Beach, Florida, United States My Florida Corp Defunct Full time

    Job SummaryWe are seeking a skilled Healthcare Specialist to join our team at My Florida Corp Defunct. As a Nurse Surveyor, you will be responsible for conducting inspections of healthcare facilities to ensure compliance with state and federal regulations.Key ResponsibilitiesConduct surveys of healthcare facilities to evaluate compliance with state and...

  • Automation Specialist

    2 weeks ago

    Delray Beach, Florida, United States ClinDCast Full time

    Automation SpecialistAt ClinDCast, we're shaping the future of healthcare by partnering with globally recognized healthcare organizations. As an Automation Specialist, you'll play a key role in our team by collaborating with teams to grasp project objectives and testing requirements. You'll utilize Functionize and other automation tools to configure and...

  • Implementation Specialist

    2 weeks ago

    Delray Beach, Florida, United States Synergy Business Consulting, Inc. Full time

    Job Title: Implementation SpecialistWe are seeking an experienced Implementation Specialist to join our team at Synergy Business Consulting, Inc. This role will be responsible for working with clients from start to finish of the implementation process as the main point of contact.Key Responsibilities:Manage customer relationships and projects effectively and...

  • Medical Laboratory Specialist

    2 weeks ago

    Delray Beach, Florida, United States Tenet Healthcare Full time

    Job Summary:We are seeking a highly skilled Medical Laboratory Specialist to join our team at Tenet Healthcare. As a Medical Laboratory Specialist, you will be responsible for performing and evaluating a variety of technical procedures in Blood Bank or Microbiology and at least one other Lab section/location based on State licensure and experience.Key...

  • Healthcare Business Process Specialist

    2 months ago

    Delray Beach, Florida, United States ClinDCast LLC Full time

    Position OverviewThe Healthcare Business Process Specialist will play a crucial role in enhancing operational efficiency within the healthcare sector. This position involves:Evaluating intricate business challenges in the healthcare field and formulating viable solutions.Engaging with stakeholders to comprehend and align with overarching enterprise...

  • Critical Care Nurse Specialist

    4 days ago

    Delray Beach, Florida, United States Delray Medical Center Full time

    At Delray Medical Center, we are seeking a highly skilled Critical Care Nurse Specialist to join our team. This is a per diem rotating position that offers a unique opportunity to work with a talented group of healthcare professionals in a fast-paced environment.As a Critical Care Nurse Specialist, you will work collaboratively with physicians, anesthesia...

  • RN Utilization Management Specialist

    2 weeks ago

    Saint Augustine Beach, Florida, United States UF Health Full time

    Job SummaryWe are seeking a skilled RN Utilization Management Specialist to join our team at UF Health. As a key member of our Utilization Management Department, you will play a critical role in ensuring that patients receive the most appropriate level of care, while also promoting efficient use of hospital resources.Key ResponsibilitiesConduct thorough...

  • Vascular Imaging Specialist

    2 weeks ago

    Delray Beach, Florida, United States Tenet Healthcare (TFPS) Full time

    Job SummaryAs a Vascular Imaging Specialist with Tenet Healthcare (TFPS), you will play a critical role in coordinating and assisting in all activities performed in the vascular laboratory. Your expertise in operating Ultrasound equipment will enable you to perform a variety of vascular imaging procedures as indicated by physician orders and protocols.Key...

  • RN Utilization Management Specialist

    4 weeks ago

    Saint Augustine Beach, Florida, United States University of Florida Health Full time

    Job SummaryWe are seeking a skilled RN Utilization Management Specialist to join our team at the University of Florida Health. As a key member of our healthcare team, you will play a critical role in ensuring that patients receive the most appropriate level of care, while also promoting efficient use of hospital resources.Key ResponsibilitiesConduct thorough...

  • Clinical Utilization Specialist

    1 month ago

    West Palm Beach, Florida, United States St. Mary's Medical Center Full time

    Job SummaryWe are seeking a skilled Registered Nurse to join our team as a Clinical Utilization Specialist. In this role, you will be responsible for utilization review and discharge planning of all acute clinical areas.Key ResponsibilitiesConduct thorough utilization reviews to ensure accurate and efficient careDevelop and implement effective discharge...

  • Medical Laboratory Specialist

    2 weeks ago

    Delray Beach, Florida, United States Tenet Healthcare Full time

    Job Summary:We are seeking a highly skilled Medical Technologist II to join our team at Tenet Healthcare. As a Medical Technologist II, you will be responsible for performing and evaluating technical procedures in Blood Bank or Microbiology and at least one other Lab section/location based on State licensure and experience.Key Responsibilities:Utilize all...

  • Medical Laboratory Specialist

    1 month ago

    Delray Beach, Florida, United States Tenet Healthcare Full time

    Job Summary:We are seeking a highly skilled Medical Technologist II to join our team at Tenet Healthcare. As a Medical Technologist II, you will be responsible for performing and evaluating a variety of technical procedures in Blood Bank or Microbiology and at least one other Lab section/location based on State licensure and experience.Key...

  • QNXT Specialist

    4 weeks ago

    Delray Beach, Florida, United States ClinDCast LLC Full time

    Job Title: QNXT SpecialistWe are seeking a highly skilled QNXT Specialist to join our team at ClinDCast LLC. As a key member of our healthcare payer operations team, you will be responsible for leveraging your expertise in the QNXT data model to design and implement innovative solutions that drive business growth and efficiency.Key Responsibilities:Utilize...

  • Clinical Utilization Specialist

    1 month ago

    West Palm Beach, Florida, United States St. Mary's Medical Center Full time

    Job SummaryWe are seeking a skilled Registered Nurse to join our team as a Clinical Utilization Specialist. In this role, you will be responsible for reviewing patient cases and developing effective discharge plans to ensure seamless transitions of care.Key ResponsibilitiesConduct thorough reviews of patient cases to identify opportunities for improved care...

  • Physician - Telemedicine Specialist

    2 weeks ago

    Delray Beach, Florida, United States HeliosX Full time

    About the Role:HeliosX is a leading healthcare company that's revolutionizing the way healthcare is delivered. We're looking for a skilled Physician to join our team as a Telemedicine Specialist.Key Responsibilities:Review patient consultations and prescribe non-controlled low-risk medicinesLog on to our websites to access patient information and e-prescribe...

  • Physician - Telemedicine Specialist

    1 month ago

    Delray Beach, Florida, United States HeliosX Full time

    About the RoleWe are seeking a skilled physician to join our team at HeliosX, a leading healthcare company that is revolutionizing the way healthcare is delivered. As a telemedicine specialist, you will play a critical role in providing high-quality patient care and treatment through our innovative telemedicine platform.Key Responsibilities:Review and...

Healthcare Utilization Review Specialist

2 months ago

Delray Beach, Florida, United States Staffosaurus Full time

About Staffosaurus

Staffosaurus is a leading provider of billing management services, dedicated to delivering high-quality, cost-effective solutions to our clients. Our mission is to ensure that our clients receive maximum insurance reimbursements in the shortest possible time, while maintaining the highest level of professionalism, ethics, and transparency.

Job Summary

We are seeking a highly skilled Utilization Review Specialist to join our team. The successful candidate will be responsible for performing utilization reviews to ensure accurate reimbursement by third-party payers. This will involve managing concurrent reviews for multiple locations and levels of care, as well as the denial/appeals process and the flow, organization, and reporting of information.

Key Responsibilities

  • Utilization Review: Obtain preauthorization for admissions and continued stays according to third-party guidelines within one business day of admission, including researching and obtaining necessary insurance contact information and coordinating scheduled meetings between hospital and insurance doctors.
  • Denials and Appeals: Manage and perform the processes for retrospective authorizations and denials/appeals, ensuring timely communication of preauthorization outcomes, follow-up instructions, options, and related information to relevant administrative and clinical staff.
  • Documentation and Reporting: Document activity in billing and utilization review software and prepare reports for meetings and management review, organizing and filing documents for ease of access in approved locations.
  • Data Analysis: Assist in compiling information for data analysis relating to preauthorization and reimbursement, providing assistance to facility staff in determining the likelihood of insurances covering treatment.
  • Confidentiality and Compliance: Maintain patient confidentiality in accordance with state and federal law, participating in internal information meetings, required in-service education and training, and company-wide performance improvement and compliance activities.

Requirements

  • Education: Master's degree from an accredited college or university in social work, mental health, nursing, or related degree.
  • Experience: Two years of UR experience in a hospital or healthcare insurance setting.
  • Licensure: LMSW, LMHC, LPC, or other healthcare-related licensure preferred.

Benefits

  • Competitive Pay: $60,000 - $70,000 per year.
  • Benefits Package: Medical, vision, dental, life insurance, retirement plans, and PTO.

Work Environment

  • Remote Work: This is a full-time remote position.