Utilization Review Specialist
4 weeks ago
ESSENTIAL FUNCTIONS:•Act as liaison between managed care organizations and the facility professional clinical staff.•Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.•Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.•Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.•Conduct quality reviews for medical necessity and services provided.•Facilitate peer review calls between facility and external organizations.•Initiate and complete the formal appeal process for denied admissions or continued stay.•Assist the admissions department with pre-certifications of care.•Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.OTHER FUNCTIONS:•Perform other functions and tasks as assigned.EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:•Associate's degree in nursing (LPN or RN) required. Bachelor's or Master's degree in social work, behavioral or mental health, nursing or other related health field preferred.•Two or more years' experience with the population of the facility and previous experience in utilization management preferred.LICENSES/DESIGNATIONS/CERTIFICATIONS:•Current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.•CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.•First aid may be required based on state or facility requirements.Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
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Program Specialist
3 weeks ago
Memphis, United States Veterans Health Administration Full timeSummary The position of Program Specialist is in the office of Quality and Patient Safety. In this capacity, the employee participates actively in the operations of Risk Management under the Department of Quality and Patient Safety. The employee must have a high degree of analytical ability and knowledge of quality management, risk management, legal...
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Occupancy Specialist
7 days ago
Memphis, United States McCormack Baron Management Inc. Full timeOccupancy Specialist Reports to the Property Manager Date Written or Revised: November 17, 2023 FLSA: Non-Exempt Key Responsibilities (Essential Duties and Functions) This list of duties and responsibilities is not all-inclusive and may expand to include other duties and responsibilities based on business need. * Assist the Site Manager with the...
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UR Specialist: PRN
2 weeks ago
Memphis, United States Acadia Healthcare Inc. Full timeESSENTIAL FUNCTIONS: At Crestwyn Behavioral Health, you will have an opportunity to shine in your Utilization Review skills! You will: * Act as liaison between managed care organizations and the facility professional clinical staff. * Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations...
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Health System Specialist
3 weeks ago
Memphis, United States Veterans Health Administration Full timeSummary The Health System Specialist -Credentialing and Privileging Specialist is assigned to the Medical Staff Office, which is under the Chief of Staff at a VA Medical Center (VAMC) and is responsible for providing administrative and technical direction and support to the credentialing and privileging (C&P) operations. The C&P Specialist is aligned...
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Operation Support Specialist
2 weeks ago
Memphis, United States Usiinc Full timeOperation Support Specialist page is loaded **Operation Support Specialist** **Operation Support Specialist** locationsMemphis, TN posted onPosted 5 Days Ago job requisition idR-107086 **We are looking for individuals who are eager to develop and apply their skills in ways that make a positive impact to communities. Here, youll be proud to be a part of a...
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Account Resolution Specialist
3 weeks ago
Memphis, United States VRC Companies Full timeJob Description Job Description Description: $16 - $21 PER HOUR + BENEFITS Position Summary: The Account Resolution Specialist is a position reporting directly to the Senior Account Resolution Specialist and will fill a critical role within the business to help improve the overall process of cash collections. This position is responsible for supporting their...
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Account Resolution Specialist
4 weeks ago
Memphis, United States VRC Companies Full timeJob DescriptionJob DescriptionDescription:$16 - $21 PER HOUR + BENEFITSPosition Summary: The Account Resolution Specialist is a position reporting directly to the Senior Account Resolution Specialist and will fill a critical role within the business to help improve the overall process of cash collections. This position is responsible for supporting their...
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Patient Outreach Services Specialist
3 weeks ago
Memphis, United States Upperline Health Full timeJob DescriptionJob DescriptionAbout UsUpperline Health is the nation’s largest provider dedicated to lower extremity, wound and vascular care. Founded in 2017 with the ambitious goal of changing specialty care, Upperline Health delivers a more efficient path for patients to receive consistent and effective treatment for chronic illnesses. Triage is...
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eCommerce Fulfillment Specialist
3 days ago
Memphis, United States DPDHL Full timeFLEX Schedule eCommerce Fulfillment Specialist Role Profile Role Purpose: The eCommerce Fulfillment Specialist is a cross-functional position trained in multiple areas of the operation, including inbound processing, order fulfillment, order packaging, and customer returns processing. This role’s primary responsibility will be the safe, secure, and accurate...
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Nephrology Specialist
2 weeks ago
Memphis, United States Monogram Health Full timePosition: Nephrology Physician Monogram Health is seeking a skilled and compassionate full-time Nephrologist to join our team in delivering value-based care to patients with kidney diseases. The ideal candidate will be passionate about improving patient outcomes for patients with kidney disease, reducing healthcare costs, and enhancing the overall quality...
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Data Entry Specialist
1 day ago
Memphis, United States Randstad Enterprise Full timeW2 ONLY - NO C2C or 1099Seeking a Data Entry Specialist for a large medical devices company in Memphis TN. This will be a 3 month assignment (unless extended further by the client)ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned:Gathering, collating, and preparing documents, materials, and information for data...
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Data Entry Specialist
1 day ago
Memphis, United States Randstad Enterprise Full timeW2 ONLY - NO C2C or 1099Seeking a Data Entry Specialist for a large medical devices company in Memphis TN. This will be a 3 month assignment (unless extended further by the client)ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned:Gathering, collating, and preparing documents, materials, and information for data...
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Data Entry Specialist
20 hours ago
Memphis, United States Randstad Enterprise Full timeW2 ONLY - NO C2C or 1099Seeking a Data Entry Specialist for a large medical devices company in Memphis TN. This will be a 3 month assignment (unless extended further by the client)ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned:Gathering, collating, and preparing documents, materials, and information for data...
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Remote Revenue Cycle Specialist- A/R
2 weeks ago
Memphis, United States NSN Revenue Resources Full timeJob Type Full-time Description We are seeking an experienced and detail-oriented Accounts Receivable Specialist to join our central billing office team for ambulatory surgery centers. The successful candidate will play a crucial role in resolving outstanding surgical claims resulting in maximum reimbursement. Responsibilities: Timely follow-up and...
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Warehouse Associate, Services Specialist
6 days ago
Memphis, United States Juice Plus + Full timeSummary: The Juice Plus+ Company is a $700+ million competitor in the health and wellness industry, utilizing a unique combination of direct sales and e-commerce to market our carefully curated line of plant-based nutritional products and Tower Garden aeroponic growing systems in pursuit of our mission to Inspire Healthy Living Around the World. We operate...
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Warehouse Associate, Services Specialist
3 days ago
Memphis, United States Juice Plus + Full timeSummary: The Juice Plus+ Company is a $700+ million competitor in the health and wellness industry, utilizing a unique combination of direct sales and e-commerce to market our carefully curated line of plant-based nutritional products and Tower Garden® aeroponic growing systems in pursuit of our mission to “Inspire Healthy Living Around the World.” We...
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Credit & Collections Specialist I
7 days ago
Memphis, United States Highline Aftermarket Full timeCredit & Collections Application Specialist The Credit & Collections Application Specialist will be responsible for monitoring/managing customers accounts. The successful candidate will need to maintain spreadsheets and a database for their assigned accounts. They must uphold the companys policies and image with customers, therefore contributing to its...
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Warehouse Data Specialist
4 days ago
Memphis, United States Trisian-Global Consulting LLC Full timeJob DescriptionJob DescriptionTrisian-Global Consulting is seeking a Warehouse Data Specialist with experience using Power BI. This is a contract for hire opportunity, on-site in Memphis.Extract data using specialist applications/software including Power BIRespond to data-related queriesHelp management identify and create processes to make data processing...
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Document Management Specialist
2 weeks ago
Memphis, United States AutoZone Full timePosition Summary: The Document Management Specialist provides support to the Property Management Department and reports to the Scanning Project Supervisor. This position is responsible for directing the scanning and coding of electronic and paper commercial real estate legal documents, identification and organization of legal documents, as well as monitoring...
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Document Management Specialist
3 days ago
Memphis, United States AutoZone Full timePosition Summary: The Document Management Specialist provides support to the Property Management Department and reports to the Scanning Project Supervisor. This position is responsible for directing the scanning and coding of electronic and paper commercial real estate legal documents, identification and organization of legal documents, as well as monitoring...