Clinical Utilization Reviewer
7 hours ago
Genex Service LLC is seeking a skilled Utilization Reviewer to join our team. As a Utilization Reviewer, you will be responsible for performing precertification reviews for New Jersey auto accident PIP medical treatment referrals. You will use your critical thinking and clinical judgment to ensure that treatment is medically necessary and authorized. This is a remote opportunity that offers a supportive and fast-paced environment.
Responsibilities:
- Perform utilization reviews and precertification reviews for New Jersey auto accident PIP medical treatment referrals.
- Use critical thinking and clinical judgment to ensure that treatment is medically necessary and authorized.
- Collaborate with healthcare providers, claims adjusters, and other stakeholders to gather relevant information for comprehensive assessments.
- Evaluate medical documentation to ensure compliance with industry standards and regulatory requirements.
- Communicate findings clearly and concisely through written reports and verbal discussions.
- Stay up-to-date on industry regulations, medical advancements, and best practices to enhance the quality of reviews.
Qualifications:
- Associates degree in Nursing or related field.
- 2-3 years of utilization experience.
- New Jersey Decision Point Review (NJ DPR) experience preferred.
Benefits:
- Full and comprehensive benefits programs starting on your first day.
- 24 days of paid vacation/holidays in your first year plus sick days.
- Employee Assistance and a Referral Program.
Salary:
$52,719 - $80,000 annually, based on skills, experience, and education.
-
Clinical Reviewer
4 days ago
Detroit, Michigan, United States Umanist Staffing LLC Full timeJob Title: Clinical ReviewerUmanist Staffing LLC is seeking a skilled Clinical Reviewer to join our team. As a Clinical Reviewer, you will be responsible for reviewing inpatient, outpatient, and ambulatory services to ensure medical necessity, appropriate length of stay, intensity of service, and level of care.Key Responsibilities:Perform prospective,...
-
Registered Nurse Utilization Review
4 weeks ago
Detroit, Michigan, United States Detroit Medical Center Full timeJob Title: Registered Nurse Utilization ReviewWe are seeking a highly skilled Registered Nurse to join our Utilization Review team at the Detroit Medical Center. As a Utilization Review RN, you will play a critical role in ensuring that patients receive the most appropriate level of care, while also optimizing resource utilization and promoting efficient...
-
Registered Nurse Utilization Review
4 weeks ago
Detroit, Michigan, United States Detroit Medical Center Full timeJob Title: Registered Nurse Utilization ReviewWe are seeking a highly skilled Registered Nurse to join our team as a Utilization Review RN. In this role, you will be responsible for ensuring that patients receive the most appropriate level of care, while also promoting efficient resource utilization.Key Responsibilities:Conduct thorough assessments of...
-
Clinical Review Specialist
3 days ago
Detroit, Michigan, United States W3R Consulting Full timeJob Title - Registered Nurse - Clinical ReviewDuration - 10 monthsLocation - RemotePay: $40.00/hr on W2We are seeking a highly skilled Registered Nurse to join our team as a Clinical Review Specialist. In this role, you will be responsible for performing prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory, and ancillary...
-
Clinical Reviewer
2 weeks ago
Detroit, Michigan, United States Genex Services, LLC. Full timeJob Title: Utilization ReviewerGenex Service LLC is seeking a skilled Utilization Reviewer to join our team. As a Utilization Reviewer, you will play a critical role in ensuring that medical treatment is necessary and appropriate for patients.Responsibilities:Perform utilization review of medical treatment requests to determine medical necessity.Collaborate...
-
Clinical Utilization Manager
4 weeks ago
Detroit, Michigan, United States McLaren Health Care Full timeClinical Utilization Management Role **Job Summary:** McLaren Health Care is seeking a skilled Registered Nurse to join our Utilization Management team. As a Clinical Utilization Manager, you will play a critical role in ensuring that hospital admissions are based on medical necessity and that documentation is sufficient to support the level of care being...
-
Clinical Utilization Manager
4 weeks ago
Detroit, Michigan, United States McLaren USA Full timeJob SummaryWe are seeking a skilled Clinical Utilization Manager to join our team at McLaren USA. As a key member of our healthcare team, you will play a critical role in ensuring the efficient use of hospital resources and promoting high-quality patient care.Key ResponsibilitiesConduct concurrent and retrospective reviews to ensure that patients receive the...
-
Clinical Utilization Manager
4 weeks ago
Detroit, Michigan, United States McLaren Health Care Full timeJob SummaryWe are seeking a highly skilled Registered Nurse to join our Utilization Management team at McLaren Health Care. As a Clinical Utilization Manager, you will play a critical role in ensuring that hospital admissions are based on medical necessity and that documentation is sufficient to support the level of care being billed.Key...
-
Clinical Review Specialist
6 hours ago
Detroit, Michigan, United States LanceSoft Full timeJob SummaryWe are seeking a skilled Clinical Review Specialist to join our team at LanceSoft. In this role, you will be responsible for conducting thorough reviews of inpatient, outpatient, and ambulatory services to ensure medical necessity and appropriate care.Key Responsibilities:Perform prospective, concurrent, and retrospective reviews of healthcare...
-
Clinical Utilization Manager
3 weeks ago
Detroit, Michigan, United States McLaren Health Care Full timeJob SummaryWe are seeking a highly skilled and experienced Registered Nurse to join our Utilization Management team. As a Clinical Utilization Manager, you will play a critical role in ensuring that hospital admissions are based on medical necessity and that documentation is sufficient to support the level of care being billed.Key ResponsibilitiesConduct...
-
Clinical Review Specialist
2 days ago
Detroit, Michigan, United States LanceSoft Full timeJob SummaryWe are seeking a highly skilled Clinical Review Specialist to join our team at LanceSoft. As a key member of our post-acute care review team, you will be responsible for ensuring the medical necessity of services provided to our members.Key Responsibilities:Conduct prospective, concurrent, and retrospective medical necessity reviews of post-acute...
-
Clinical Utilization Manager
3 weeks ago
Detroit, Michigan, United States McLaren USA Full timeJob SummaryWe are seeking a highly skilled and experienced Registered Nurse to join our team as a Utilization Management Nurse. In this role, you will be responsible for determining the appropriate patient status based on regulatory and reimbursement requirements of various commercial and government payers in collaboration with the admitting/attending...
-
Clinical Review Nurse
2 weeks ago
Detroit, Michigan, United States LanceSoft Full timeJob SummaryWe are seeking a highly skilled Clinical Review Nurse to join our team at LanceSoft. As a key member of our healthcare team, you will be responsible for conducting thorough medical necessity reviews of post-acute care services to ensure that patients receive the most appropriate care.Key ResponsibilitiesConduct prospective, concurrent, and...
-
Clinical Review Nurse
2 weeks ago
Detroit, Michigan, United States LanceSoft Full timeJob SummaryWe are seeking a highly skilled Clinical Review Nurse to join our team at LanceSoft. As a key member of our healthcare team, you will be responsible for performing prospective, concurrent, and retrospective medical necessity reviews of post-acute care services to ensure medical necessity for appropriate setting and length of stay.Key...
-
Nurse Utilization Review Specialist
4 weeks ago
Detroit, Michigan, United States Detroit Medical Center Full timeJob Title: Registered Nurse - Utilization ReviewAt the Detroit Medical Center, we are seeking a highly skilled Registered Nurse to join our team as a Utilization Review Specialist. This role is responsible for ensuring that patients receive the most appropriate level of care, while also optimizing resource utilization and promoting efficient healthcare...
-
Clinical Review Specialist
2 weeks ago
Detroit, Michigan, United States LanceSoft Full timeJob Title: Registered Nurse-Review AnalystJob Summary:We are seeking a highly skilled Registered Nurse to join our team as a Review Analyst. In this role, you will be responsible for conducting medical necessity reviews of post-acute care services to ensure compliance with established medical policy and guidelines.Key Responsibilities:Conduct prospective,...
-
Registered Nurse
1 month ago
Detroit, Michigan, United States Detroit Medical Center Full timeJob Title: Registered Nurse - Utilization ReviewAt the Detroit Medical Center, we are seeking a highly skilled Registered Nurse to join our team as a Utilization Review Nurse. This is a full-time position that requires a strong background in nursing and a passion for delivering high-quality patient care.Job Summary:The Utilization Review Nurse will be...
-
Drug Utilization Review Specialist
3 weeks ago
Detroit, Michigan, United States destinationone Consulting Full timeJob Title: Drug Utilization Review SpecialistAt destinationone Consulting, we are seeking a highly skilled Drug Utilization Review Specialist to join our team. As a key member of our healthcare recruitment team, you will play a crucial role in evaluating medication use patterns to promote safe and effective medication therapy, ensuring optimal patient...
-
Drug Utilization Review Specialist
3 days ago
Detroit, Michigan, United States destinationone Consulting Full timeJob Title: Drug Utilization Review SpecialistDestinationone Consulting is seeking a highly skilled Drug Utilization Review Specialist to join our team. As a key member of our healthcare recruitment team, you will play a critical role in evaluating medication use patterns to promote safe and effective medication therapy.Key Responsibilities:Conduct...
-
RN Utilization Review Specialist
4 weeks ago
Detroit, Michigan, United States Detroit Medical Center Shared Services Full timeJob SummaryWe are seeking a skilled RN Utilization Review Specialist to join our team at the Detroit Medical Center Shared Services. As a key member of our case management team, you will play a critical role in ensuring that patients receive the most appropriate level of care while promoting efficient resource utilization.Key ResponsibilitiesFacilitate...