Utilization Review Specialist

* SIGN-ON BONUS: $5,000 - if Licensed Registered Nurse (RN) 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...

Job DescriptionAdditional Job InformationPhysical Requirements•Climbing – 26-75%•Grasping, Pinching and Holding – 26-75%•Lifting or Carrying – 26-75%•Pushing or Pulling – 26-75%•Reaching Overhead – 0-25%•Sitting – 76-100%•Squatting, Bending, Kneeling – 26-75%•Standing – 26-75%•Walking or Moving – 0-25%•Weights Lifted...

Job DescriptionAdditional Job InformationPhysical Requirements•Climbing – 26-75%•Grasping, Pinching and Holding – 26-75%•Lifting or Carrying – 26-75%•Pushing or Pulling – 26-75%•Reaching Overhead – 0-25%•Sitting – 76-100%•Squatting, Bending, Kneeling – 26-75%•Standing – 26-75%•Walking or Moving – 0-25%•Weights Lifted...

Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. 80% May provide any of the...

Job Description Additional Job Information Physical Requirements •Climbing – 26-75%•Grasping, Pinching and Holding – 26-75%•Lifting or Carrying – 26-75%•Pushing or Pulling – 26-75%•Reaching Overhead – 0-25%•Sitting – 76-100%•Squatting, Bending, Kneeling – 26-75%•Standing – 26-75%•Walking or Moving – 0-25%•Weights...

Job DescriptionAdditional Job InformationPhysical Requirements•Climbing – 26-75%•Grasping, Pinching and Holding – 26-75%•Lifting or Carrying – 26-75%•Pushing or Pulling – 26-75%•Reaching Overhead – 0-25%•Sitting – 76-100%•Squatting, Bending, Kneeling – 26-75%•Standing – 26-75%•Walking or Moving – 0-25%•Weights Lifted...

Job Type Full-time Description This position is a full-time, permanent non-clinical position onsite or remote in state within Tennessee Orthopaedic Alliance in Columbia, TN. The Refund Specialist is an important part of the TOA Revenue Cycle Team that focuses on revenue cycle excellence. As a Refund Specialist, you will use your analytical, financial, and...

Job Type Full-time Description This position is a full-time, permanent non-clinical position onsite or remote in state within Tennessee Orthopaedic Alliance in Columbia, TN. The Refund Specialist is an important part of the TOA Revenue Cycle Team that focuses on revenue cycle excellence. As a Refund Specialist, you will use your analytical, financial, and...

Medical Billing Specialist In-Office Position.Medical Billing Specialist. The ideal candidate will be responsible for all aspects of billing including accounts receivables, managing claims from the time of claim submission to payment posting, etc. Qualifications:Medical Billing Certification.3+ years of previous medical collections experience with general...

*SIGN-ON BONUS: $5,000 if Licensed Registered Nurse (RN) ESSENTIAL FUNCTIONS:Provide consultation and guidance regarding admissions and patient length of stay to a variety of payers. Secure authorizations with insurance companies for inpatient treatment and continue to obtain authorizations for duration of patient stay. Evaluate the utilization program for...

Our client, an industry leader in infusion and in-home health care represented across the southeast is seeking an *Insurance Case Manager/Patient Account Specialist* to join their team! This is a permanent opportunity offering benefits.This role will work closely with clinical staff coordinating patient care and will verify patient’s health benefits and...

Summary Duties This position serves as a Supervisory Inventory Management Specialist for non-expendable (NX) assets/materials for the Logistics Service within the VA Health Care System supervising multiple supply or material classes/series and recognized as the Material Management Division's subject matter expert serving as an advisor and...

Job Title: Appeals Specialist Location: Columbia, SC. 29229 (4-6 weeks onsite training, then possibility to transition into remote) Duration: 3 months assignment with possible extension. Shift: Mon-Fri 8 AM - 5 PM Payrate: $17/hr.Responsibilities: Performs non-medical reviews and processes redetermination letters. 50% Performs non-medical reviews and...

Summary THIS IS A NATIONAL GUARD TITLE 32 EXCEPTED SERVICE POSITION.This National Guard position is for a GS LOGISTICS MANAGEMENT SPECIALIST (TITLE 32), Position Description Number D in SPMD 2242 and is part of the MO HHD 175th Military Police Battalion.APPOINTMENT FACTORS: This is an Indefinite/Permanent (may retain current tenure if on-board) Excepted...

Job DescriptionJob DescriptionProduction Specialists work in a dynamic, creative and fast-paced environment to create and assemble sign and graphic products for many different business applications. Creative work is performed within the FASTSIGNS Center sign production area that is fully equipped with top-of-the-line sign-making equipment.Position...

Job DescriptionJob DescriptionWe are seeking a meticulous and detail-oriented individual to join our team as a Group Profile and Data Entry Specialist. In this role, you will be responsible for setting up new group profiles in our database, reviewing and gathering data to provide accurate quotes, entering census data into Excel, and assigning new group...

Job DescriptionJob DescriptionCommunity Relations Specialist - Game ChangersA community relations specialist will manage River’s Edge Retreat public image. As a community relations specialist, the applicant will organize volunteers, assist with coordinating special events and implement community outreach programs. It will also be the applicants'...

Responsible for reviewing and processing vendor invoices, reconciling purchasing card bills, answering vendor inquiries, reconciling vendor statements, processing and maintaining 1099 records, and processing and reconciling ACH and check disbursement Accounts Payable, Specialist, Lead, Processing, Vendor, Accounting, Insurance

Our client, an industry leader in infusion and in-home health care represented across the southeast is seeking an *Insurance Case Manager/Patient Account Specialist* to join their team! This is a permanent opportunity offering benefits. This role will work closely with clinical staff coordinating patient care and will verify patient’s health benefits and...

This premium lifestyle brand is 15+ years old and has offices on the West and East Coast. Known for their high-quality product and consumer loyalty. The brand is growing In the office full time and excellent company culture in place.We are looking for a Womens Spec & Fit Specialist with 2+ years of experience.Responsibilities & Requirements:Effectively...