Utilization Review Nurse
Troy, MI · On-site
... prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure ... Must be an RN Utilization Review background in either Managed Care of Provider environment (at ...
Utilization Review Nurse
Troy, MI · On-site
... prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure ... Must be an RN Utilization Review background in either Managed Care of Provider environment (at ...
Utilization Review- RN
Troy, MI · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity ... prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure ...
Utilization Review- RN
Troy, MI · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity ... prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure ...
RN Utilization Review Nurse
Troy, MI · On-site
$33 - $37/hr
Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization Management team. * Identifies appropriate benefits, eligibility, and ...
RN Utilization Review Nurse
Troy, MI · On-site
$33 - $37/hr
Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization Management team. * Identifies appropriate benefits, eligibility, and ...
Utilization Review Manager
New Baltimore, MI · On-site
$25 - $35/hr
Secure authorizations with insurance companies for inpatient treatment and continue to obtain ... Evaluate the utilization program for compliance with regulations, policies and procedures. * Review ...
Utilization Review Manager
New Baltimore, MI · On-site
$25 - $35/hr
Secure authorizations with insurance companies for inpatient treatment and continue to obtain ... Evaluate the utilization program for compliance with regulations, policies and procedures. * Review ...
Job Summary Utilization Review Analyst conducts prospective, concurrent, and retrospective reviews of service authorizations, ensuring the appropriate, effective, and efficient use of acute ...
Job Summary Utilization Review Analyst conducts prospective, concurrent, and retrospective reviews of service authorizations, ensuring the appropriate, effective, and efficient use of acute ...
This position supervises UR Analysts and Acute Care Authorization Analysts and provides clinical and operational oversight for crisis authorizations, concurrent reviews, acute care utilization, high ...
This position supervises UR Analysts and Acute Care Authorization Analysts and provides clinical and operational oversight for crisis authorizations, concurrent reviews, acute care utilization, high ...
Utilization Review Medical Director (Contract)
Troy, MI · On-site +1
$150/hr
The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable ... Conduct timely clinical reviews of DMEPOS authorization requests using applicable criteria ...
Utilization Review Medical Director (Contract)
Troy, MI · On-site +1
$150/hr
The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable ... Conduct timely clinical reviews of DMEPOS authorization requests using applicable criteria ...
SUMMARY: The Authorization Nurse will oversee the processing of assigned authorizations for ... Minimum 2 years' experience in a managed care environment, preferably in a utilization related role;
SUMMARY: The Authorization Nurse will oversee the processing of assigned authorizations for ... Minimum 2 years' experience in a managed care environment, preferably in a utilization related role;
Maintains current knowledge of hospital utilization review processes and participates in the resolution of retrospective reimbursement issues including appeals, PACER authorization, third party payer ...
New
Maintains current knowledge of hospital utilization review processes and participates in the resolution of retrospective reimbursement issues including appeals, PACER authorization, third party payer ...
New
Maintains current knowledge of hospital utilization review processes and participates in the resolution of retrospective reimbursement issues including appeals, PACER authorization, third party payer ...
New
Maintains current knowledge of hospital utilization review processes and participates in the resolution of retrospective reimbursement issues including appeals, PACER authorization, third party payer ...
New
Maintains current knowledge of hospital utilization review processes and participates in the resolution of retrospective reimbursement issues including appeals, PACER authorization, third party payer ...
New
Maintains current knowledge of hospital utilization review processes and participates in the resolution of retrospective reimbursement issues including appeals, PACER authorization, third party payer ...
New
Concurrent Review Nurse
Troy, MI · On-site
... and Utilization reviews and assist with Denial Letters Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization ...
Concurrent Review Nurse
Troy, MI · On-site
... and Utilization reviews and assist with Denial Letters Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization ...
... authorization requirements, and timely utilization of hospital services. Evaluates patient status ... Identifies, reviews, and documents Medicare 1 Day stays and Condition Code 44 (CC44) cases in ...
... authorization requirements, and timely utilization of hospital services. Evaluates patient status ... Identifies, reviews, and documents Medicare 1 Day stays and Condition Code 44 (CC44) cases in ...
... authorization requirements, and timely utilization of hospital services. Evaluates patient status ... Identifies, reviews, and documents Medicare 1 Day stays and Condition Code 44 (CC44) cases in ...
... authorization requirements, and timely utilization of hospital services. Evaluates patient status ... Identifies, reviews, and documents Medicare 1 Day stays and Condition Code 44 (CC44) cases in ...
Utilization Management - Through retrospective review and use of both strong QI principles and ... Provide/Aggregate data to support maintenance/updates to authorization decision guidelines.
Utilization Management - Through retrospective review and use of both strong QI principles and ... Provide/Aggregate data to support maintenance/updates to authorization decision guidelines.
Utilization Management - Through retrospective review and use of both strong QI principles and ... Provide/Aggregate data to support maintenance/updates to authorization decision guidelines.
Utilization Management - Through retrospective review and use of both strong QI principles and ... Provide/Aggregate data to support maintenance/updates to authorization decision guidelines.
Care Review Clinician - UR RN
Troy, MI · On-site
Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team - Identifies appropriate benefits, eligibility ...
Care Review Clinician - UR RN
Troy, MI · On-site
Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team - Identifies appropriate benefits, eligibility ...
This role is responsible for reviewing behavioral health services to ensure medical necessity ... Experience with behavioral health payer guidelines and authorization processes * Familiarity with ...
This role is responsible for reviewing behavioral health services to ensure medical necessity ... Experience with behavioral health payer guidelines and authorization processes * Familiarity with ...
Utilization Mgmt Spec
Southfield, MI · On-site
Completes required duties as defined for specific payers to obtain authorization numbers for payment. * Provides clerical support for Utilization Management; sorting faxes and mail, obtaining ...
Utilization Mgmt Spec
Southfield, MI · On-site
Completes required duties as defined for specific payers to obtain authorization numbers for payment. * Provides clerical support for Utilization Management; sorting faxes and mail, obtaining ...
Completes required duties as defined for specific payers to obtain authorization numbers for payment. * Provides clerical support for Utilization Management; sorting faxes and mail, obtaining ...
Completes required duties as defined for specific payers to obtain authorization numbers for payment. * Provides clerical support for Utilization Management; sorting faxes and mail, obtaining ...
Authorization Utilization Review Bcba information
What is an authorization utilization review BCBA?
An Authorization Utilization Review BCBA is responsible for reviewing treatment plans, ensuring medical necessity, and obtaining insurance authorizations for applied behavior analysis (ABA) services. They analyze data, collaborate with clinicians, and communicate with insurance providers to optimize care while adhering to policies and guidelines. Their goal is to ensure that ABA services are both effective and appropriately funded within insurance requirements.
What does an authorization utilization review BCBA do?
An Authorization Utilization Review BCBA is primarily responsible for reviewing clinical documentation to determine the medical necessity of ABA services, preparing and submitting authorization requests to insurance companies, and responding to requests for additional information. The role involves collaborating closely with clinical staff, insurance representatives, and sometimes directly with clients or caregivers to ensure all documentation meets regulatory and payer requirements. You may also provide guidance to therapy teams on proper documentation and help streamline internal utilization review processes. This position requires balancing client advocacy with payer guidelines, making each day both detailed and dynamic.
What are the key skills and qualifications needed to thrive as an authorization utilization review BCBA?
To thrive as an Authorization Utilization Review BCBA, you need a strong background in applied behavior analysis, in-depth knowledge of utilization review processes, and active BCBA certification. Familiarity with insurance authorization platforms, electronic health record (EHR) systems, and current procedural terminology (CPT) coding is typically required. Excellent analytical skills, attention to detail, and effective communication abilities set outstanding candidates apart. These skills ensure accurate authorization decisions, regulatory compliance, and efficient collaboration with providers and insurance teams.
What are the most commonly searched types of Authorization Utilization Review Bcba jobs in Michigan?
The most popular types of Authorization Utilization Review Bcba jobs in Michigan are:
What are popular job titles related to Authorization Utilization Review Bcba jobs in Michigan?
For Authorization Utilization Review Bcba jobs in Michigan, the most frequently searched job titles are:
- Evening Utilization Review Nurse
- Utilization Management Coordinator
- Behavioral Health Utilization Review
- Remote Utilization Review Social Worker
- Physician Advisor Utilization Review
- Per Diem Utilization Review Nurse
- Full Time Physician Advisor Utilization Review
- Manager Utilization Management
- Insurance Review Nurse
- Temporary Utilization Review Nurse
What job categories do people searching Authorization Utilization Review Bcba jobs in Michigan look for?
The top searched job categories for Authorization Utilization Review Bcba jobs in Michigan are:
What cities in Michigan are hiring for Authorization Utilization Review Bcba jobs?
Cities in Michigan with the most Authorization Utilization Review Bcba job openings:
Utilization Review Nurse
Troy, MI • On-site
Healthcare Support Staffing •
Recruiting and Staffing Services • 201 - 500 employees201 - 500 employees
Contractor
Re-posted yesterday
Job description
Company Description
HealthCare 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 Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
Job Description
Company: Molina Healthcare
Location: 880 Long Lake Rd Suite 600 Troy, Michigan 48098
Shift: Daytime hours
Employment: Contract: 1-2 months (possibility of going longer depending on business needs)
Company Job Description/Day to Day Duties:
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines
Provider appeals and Utilization reviews and assist with Denial Letters
Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team.
Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.
Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care.
Qualifications
Minimum Education/Qualifications/Licensures:
Must be an RN
Utilization Review background in either Managed Care of Provider environment (at least one year)
Interqual experience
Other basic computer skills necessary: Microsoft Office, Data Entry, etc.
Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.
Also has a background in patient, skilled nurses facilities, rehab, and home healthcare.
Additional Information
Apply now for immediate consideration. After applying, a recruiting consultant will contact you for pre-screening. Please provide your best phone number to contact.
Thanks and look forward to hearing from you!
About Healthcare Support
Sourced by ZipRecruiter
HealthCare 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 Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
Industry
Recruiting and staffing services
Company size
201 - 500 Employees
Headquarters location
Maitland, FL, US
Year founded
2003