telephonic utilization review

Position Summary The Utilization Review (UR) Specialist is responsible for obtaining and maintaining insurance authorizations for clients receiving substance use disorder treatment services. This position works closely with clinical staff, admissions, and insurance companies to ensure medical necessity documentation is accurate, authorizations are obtained...

Now Hiring: RN Utilization Review - Washington, DCAre you a passionate RN professional looking for a new adventure? Prime Time Healthcare is seeking dynamic individuals like you to join our team in Washington, DC and make a real impact in patient care!In this role, you'll be at the forefront of healthcare, delivering top-notch care with precision and...

 The Utilization Review Specialist coordinates insurance authorizations for individual therapy and IOP  services, ensuring clients receive appropriate and timely care. This role works closely with clinical staff,  psychiatry, and payors to gather documentation, review medical necessity, and support treatment  planning. Strong communication, attention...

RN Utilization Review * Sign-On Bonus + Housing Stipend for FT Perm*Life-in-the-mountains, perks of a full-time position with Middle Park Health, a Critical Access Hospital, Level IV Trauma Center:Middle Park Health (MPH) is a successful rural health system located in the high Rockies 1 1/2 hour west of Denver, CO with seven locations in beautiful Grand and...

Full-time Description Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Utilization Review Nurse (UR Nurse), you’ll play an important role in helping us offer customized, self-funded insurance options to our clients and members.The UR Nurse is responsible for reviewing clinical information to...

SUMMARYThe Utilization Review RN reviews client health records to ensure proper utilization of treatment resources.RESPONSIBILITIES AND DUTIES:Coordinates and reviews all medical records, as assigned to caseload.Actively participates in Case Management and Treatment Team meetingsServes as on-going educator to all departments.Responsible for reviewing patient...

About Us Specialized Care for the Patients Who Need It Most.NeuroPsychiatric Hospitals (NPH) is dedicated to providing unparalleled service to our patients, team members, physicians, and families. We dare to do things differently, bringing together compassionate care, specialized expertise, and an interdisciplinary approach to meet the unique...

We are so glad you are interested in joining Sutter Health!Organization:CPMC-California Pacific Med CenterPosition Overview:Responsible in assisting in the overall case management of designated patients in a particular program. Planning and implementing therapeutic interventions designed to promote optimal level of functioning and transition to a lower...

Utilization review nurses perform frequent case reviews, check medical records, speak with patients and care providers regarding treatment, and respond to the plan of care. They also make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

Summary:  The primary responsibility of this role consists of reviewing member transportation requests that are over the contractual mileage guidelines.ESSENTIAL FUNCTIONSReviewing and making approval/denial determinations for all member transportation requests that are outside of the geographical mileage guidelines and reviewing requests to non-covered...

Odyssey House is looking for a Full-Time Utilization Review Specialist.Summary: Odyssey House's Mission is "Empowering people to heal and build better lives. We are dedicated to helping individuals and families reclaim their lives through effective substance use treatment, medical care, prevention, and mental health services. Odyssey House continues to...

DescriptionWe are seeking a Director of Utilization Review (UR) to join our team. The Director of UR is responsible for overseeing the processes that ensure patient care is medically necessary, efficient, and appropriately reimbursed. This role operates at the intersection of clinical care, hospital finance, and health insurance to monitor bed days, prevent...

Company DescriptionHealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail...

Utilization Review Specialist Englewood, New JerseyTypeFull TimeWhat you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use...

Overview Join an award-winning team of dedicated professionals committed to our core values of quality, compassion, and community! Dallas Regional Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference. Dallas Regional Medical Center is a...

Where You’ll Work CHI St. Vincent, a regional health network serving Arkansas, is part of CommonSpirit Health. We have served Arkansas since 1888 with a history of many firsts. Together with more than 4500 coworkers, 1000 medical staff and 500 volunteers we consistently receive praise for care advancements. CommonSpirit Health was formed by the...

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties*** JOB DESCRIPTION: RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. JOB RESPONSIBILITIES: This position is...

Company DescriptionIntegrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide...

DescriptionJob SummaryThe Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals activities. This role collaborates with payers, hospital staff, and clinical specialists to secure timely authorizations for hospital admissions and extended stays. The Utilization Review...

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full.  Below, you’ll find other important information about this position. Responsible for working in collaboration with the Medical Director on driving the...