The Utilization Review Specialist monitors patient charts and records to evaluate care concurrent with the patients treatment. Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Being a Utilization Review Specialist collects and complies data as required and according to applicable policies and regulations. Reviews treatment plans and status of approvals from insurers. In addition, Utilization Review Specialist consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Reg ...istered Nurse(RN). Being a Utilization Review Specialist contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. Working as a Utilization Review Specialist typically requires 4 to 7 years of related experience.More Show Less
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Overview. Title: Billing Utilization Specialist (Substance Use and Mental Health Services). General Purpose. Make sure services provided (like therapy, IOP, detox, MAT, etc.) are properly documented, billed, and reimbursed. Review clinical documentation to ensure it matches insurance requirements. Maximize reimbursement while staying fully compliant with healthcare laws and payer contracts. Key Responsibilities. Utilization Review. Check that ser...
UTILIZATION REVIEW SPECIALIST. . Purpose of Job Position. Responsible for ensuring appropriate communication with third-party payers to authorize hospital stays. Gathers clinical information for submission to complete timely, high-quality initial and continued reviews. Communicates this information with providers, payors, Floor Case Managers, and appropriate Business Office staff. Works to avoid any hospital stay denials with third-party payer...
Employment Type: Full-Time. Hours Per Week: 40. In this role, you will. Act as liaison between managed care organizations and the facility’s 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. Inform clinical and medical staff of any specific concerns that would extend...
Description. Our Story. Imagine being part of a team that’s not just shaping the future but actively driving it. At. Davies North America. we’re at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors. We are on the lookou...
Coachella Valley Behavioral Health, a new premier inpatient treatment center for adults age 18 and older, is opening soon and will set the standard for nursing care in behavioral health. Our 80-bed hospital offers comprehensive training, dynamic leadership, and personalized support so you can achieve your greatest potential. The UR Specialist will proactively monitor utilization of services for patients to optimize reimbursement for the facility....
Coachella Valley Behavioral Health, a new premier inpatient treatment center for adults age 18 and older, is opening soon and will set the standard for nursing care in behavioral health. Our 80-bed hospital offers comprehensive training, dynamic leadership, and personalized support so you can achieve your greatest potential. The UR Specialist will proactively monitor utilization of services for patients to optimize reimbursement for the facility....
Coachella Valley Behavioral Health, a new premier inpatient treatment center for adults age 18 and older, is opening soon and will set the standard for nursing care in behavioral health. Our 80-bed hospital offers comprehensive training, dynamic leadership, and personalized support so you can achieve your greatest potential. The UR Specialist will proactively monitor utilization of services for patients to optimize reimbursement for the facility....
Looking for UR Specialist with experience in SUD. The Utilization Review Specialist is responsible for monitoring adherence to the facilities Utilization Review plan to ensure the effective and efficient use of SUD services and monitor the appropriateness of facility admissions and extended stays in each program for insurance purposes. SUD UR experience is a MUST. ESSENTIAL DUTIES AND RESPONSIBILITIES. 1. Maintain Smartsheets with client informat...
THIS IS A REMOTE PRN (AS NEEDED) POSITION. Position Title. Utilization Review Specialist. Department. Administration. Reports To. Director, Utilization Review. Supervises. NA. Entry Level Qualifications. Health care degree‑Bachelors preferred. Two years minimum experience in utilization review. Must possess good grammatical and communication skills. Must be skilled in office equipment i.e. typewriter, calculator, computer, copy machine and fax ma...
THIS IS A REMOTE PRN (AS NEEDED) POSITION. Position Title. Utilization Review Specialist. . Department. Administration. . Reports To. Director, Utilization Review. . Supervises. NA. . Entry Level Qualifications. Health care degree‑Bachelors preferred. Two years minimum experience in utilization review. Must possess good grammatical and communication skills. Must be skilled in office equipment i.e. typewriter, calculator, computer, copy machine an...
THIS IS A REMOTE PRN (AS NEEDED) POSITION. Position Title. Utilization Review Specialist. Department. Administration. Reports To. Director, Utilization Review. Supervises. NA. Entry Level Qualifications. Health care degree‑Bachelors preferred. Two years minimum experience in utilization review. Must possess good grammatical and communication skills. Must be skilled in office equipment i.e. typewriter, calculator, computer, copy machine and fax ma...
THIS IS A REMOTE PRN (AS NEEDED) POSITION. Position Title. Utilization Review Specialist. . Department. Administration. . Reports To. Director, Utilization Review. . Supervises. NA. . Entry Level Qualifications. Health care degree‑Bachelors preferred. Two years minimum experience in utilization review. Must possess good grammatical and communication skills. Must be skilled in office equipment i.e. typewriter, calculator, computer, copy machine an...
