... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... Reports appropriate denial, and authorization information to designated resource. * Actively ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... Reports appropriate denial, and authorization information to designated resource. * Actively ...
Previous utilization review experience in a psychiatric healthcare facility preferred. * License ... Reports appropriate denial, and authorization information to designated resource. * Actively ...
Previous utilization review experience in a psychiatric healthcare facility preferred. * License ... Reports appropriate denial, and authorization information to designated resource. * Actively ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... Reports appropriate denial, and authorization information to designated resource. * Actively ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... Reports appropriate denial, and authorization information to designated resource. * Actively ...
Previous utilization review experience in a psychiatric healthcare facility preferred. * License ... Reports appropriate denial, and authorization information to designated resource. * Actively ...
Previous utilization review experience in a psychiatric healthcare facility preferred. * License ... Reports appropriate denial, and authorization information to designated resource. * Actively ...
UTILIZATION REVIEW RN
Seymour, IN · On-site
Utilization Review and Medical Necessity * Concurrent Review and Length of Stay Management ... Payer Communication & Authorization * Denials Management and Appeals Equal Opportunity Employer ...
UTILIZATION REVIEW RN
Seymour, IN · On-site
Utilization Review and Medical Necessity * Concurrent Review and Length of Stay Management ... Payer Communication & Authorization * Denials Management and Appeals Equal Opportunity Employer ...
UTILIZATION REVIEW RN
Seymour, IN · On-site
... DUTIES 1. Utilization Review and Medical Necessity 2. Concurrent Review and Length of Stay ... Authorization 5. Denials Management and Appeals Equal Opportunity Employer This employer is ...
UTILIZATION REVIEW RN
Seymour, IN · On-site
... DUTIES 1. Utilization Review and Medical Necessity 2. Concurrent Review and Length of Stay ... Authorization 5. Denials Management and Appeals Equal Opportunity Employer This employer is ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... Reports appropriate denial, and authorization information to designated resource. * Actively ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... Reports appropriate denial, and authorization information to designated resource. * Actively ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... Reports appropriate denial, and authorization information to designated resource. * Actively ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... Reports appropriate denial, and authorization information to designated resource. * Actively ...
... thorough review of the total resources available to patient pre and post-discharge from ... Completes pre-certification and prior authorization timely for admission and or services. Documents ...
Quick apply
... thorough review of the total resources available to patient pre and post-discharge from ... Completes pre-certification and prior authorization timely for admission and or services. Documents ...
... thorough review of the total resources available to patient pre and post-discharge from ... Completes pre-certification and prior authorization timely for admission and or services.
... thorough review of the total resources available to patient pre and post-discharge from ... Completes pre-certification and prior authorization timely for admission and or services.
... thorough review of the total resources available to patient pre and post-discharge from ... Completes pre-certification and prior authorization timely for admission and or services.
... thorough review of the total resources available to patient pre and post-discharge from ... Completes pre-certification and prior authorization timely for admission and or services.
... thorough review of the total resources available to patient pre and post-discharge from ... Completes pre-certification and prior authorization timely for admission and or services.
... thorough review of the total resources available to patient pre and post-discharge from ... Completes pre-certification and prior authorization timely for admission and or services.
Assigned projects span drug coverage administration, Preferred Drug List (PDL) management, prior authorization, utilization management, drug utilization review, clinical criteria configuration, and ...
Assigned projects span drug coverage administration, Preferred Drug List (PDL) management, prior authorization, utilization management, drug utilization review, clinical criteria configuration, and ...
Assigned projects span drug coverage administration, Preferred Drug List (PDL) management, prior authorization, utilization management, drug utilization review, clinical criteria configuration, and ...
Assigned projects span drug coverage administration, Preferred Drug List (PDL) management, prior authorization, utilization management, drug utilization review, clinical criteria configuration, and ...
Clinical Domain Project Manager (PBM)
Indianapolis, IN · On-site
$110 - $150/hr
Assigned projects span drug coverage administration, Preferred Drug List (PDL) management, prior authorization, utilization management, drug utilization review, clinical criteria configuration, and ...
Clinical Domain Project Manager (PBM)
Indianapolis, IN · On-site
$110 - $150/hr
Assigned projects span drug coverage administration, Preferred Drug List (PDL) management, prior authorization, utilization management, drug utilization review, clinical criteria configuration, and ...
Utilization Management Rep I
Indianapolis, IN · On-site
$15.96 - $18/hr
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. How you will make an impact: * Managing incoming calls or ...
Utilization Management Rep I
Indianapolis, IN · On-site
$15.96 - $18/hr
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. How you will make an impact: * Managing incoming calls or ...
Utilization Management Rep I
$15.96 - $18/hr
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. How you will make an impact: * Managing incoming calls or ...
Utilization Management Rep I
$15.96 - $18/hr
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. How you will make an impact: * Managing incoming calls or ...
Utilization Management Rep I
Indianapolis, IN · On-site
$15.96 - $18/hr
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. How you will make an impact: * Managing incoming calls or ...
Utilization Management Rep I
Indianapolis, IN · On-site
$15.96 - $18/hr
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. How you will make an impact: * Managing incoming calls or ...
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain ...
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain ...
Utilization Management Rep I
Indianapolis, IN · On-site
$15.96 - $18/hr
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. How you will make an impact: * Managing incoming calls or ...
Utilization Management Rep I
Indianapolis, IN · On-site
$15.96 - $18/hr
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. How you will make an impact: * Managing incoming calls or ...
Authorization Utilization Review information
What is authorization utilization review?
Authorization Utilization Review is a process used by healthcare organizations and insurance companies to assess the medical necessity and appropriateness of medical services before they are provided. The main goal is to ensure that patients receive care that is effective, efficient, and covered by their health plan. This review typically involves evaluating patient records, treatment plans, and provider requests to decide if the requested services meet established guidelines. By doing so, it helps control healthcare costs and ensures quality care for patients.
What are the key skills and qualifications needed to thrive as an authorization utilization review specialist?
To thrive as an Authorization Utilization Review Specialist, you need a solid understanding of medical terminology, healthcare regulations, and insurance policies, often backed by a clinical background or relevant certifications. Familiarity with utilization management software, electronic health records (EHR), and payer portals is typically required. Strong attention to detail, analytical thinking, and effective communication are vital soft skills for coordinating with providers and payers. These skills ensure accurate authorization decisions, regulatory compliance, and efficient patient care coordination.
What are some common challenges faced by professionals in authorization utilization review roles, and how can they be addressed?
Professionals in Authorization Utilization Review often encounter challenges such as managing high caseloads, navigating complex insurance guidelines, and ensuring timely communication with providers and patients. Staying organized and up-to-date with evolving payer requirements is essential to avoid delays or denials. Building strong collaboration with clinical teams and leveraging electronic health record systems can help streamline workflows and improve efficiency in the review process.
What is the difference between Authorization Utilization Review vs Claims Reviewer?
| Aspect | Authorization Utilization Review | Claims Reviewer |
|---|---|---|
| Credentials | Typically requires healthcare or insurance-related certifications, such as RN, CPC, or licensed healthcare professionals | Often requires similar credentials, focusing on insurance policies and claims processing |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Insurance companies, third-party administrators, healthcare organizations |
| Industry Usage | Used to assess medical necessity before approving services | Used to evaluate claims for payment accuracy and compliance |
Authorization Utilization Review and Claims Reviewer roles both involve insurance and healthcare knowledge, but Authorization Utilization Review focuses on pre-authorization of services, while Claims Review centers on post-service claims assessment. Understanding these differences helps clarify career paths and job expectations in healthcare insurance.
What are popular job titles related to Authorization Utilization Review jobs in Indiana?
For Authorization Utilization Review jobs in Indiana, the most frequently searched job titles are:
- No Experience Utilization Review Nurse
- Night Utilization Review Nurse
- No Experience Utilization Management Nurse
- Contract Utilization Review Nurse
- Remote Utilization Review Rn
- Per Diem Chart Review Nurse
- Remote Utilization Review Social Worker
- Remote Medical Record Review Nurse
- Flex Schedule Remote Utilization Review Nurse
- Registered Nurse Utilization Review
What job categories do people searching Authorization Utilization Review jobs in Indiana look for?
The top searched job categories for Authorization Utilization Review jobs in Indiana are:
- Utilization Review Nurse Compact License
- Lpn Utilization Review
- Full Time Navihealth Utilization Review
- Optum Utilization Review Nurse
- Per Diem Optum Utilization Review
- Flex Schedule Utilization Review
- Medical Claims Review Nurse
- Remote Dental Utilization Review
- Weekend Utilization Review
- Online Utilization Review
What cities in Indiana are hiring for Authorization Utilization Review jobs?
Cities in Indiana with the most Authorization Utilization Review job openings:
Specialist, Utilization Review
Lafayette, IN
Lifepoint Health •
Health Care and Social Assistance • 10K+ employees10,000+ employees
5.9
Based on 272 frontline employees who took The Breakroom Quiz
764th of 893 rated healthcare providers
People enjoy working here
Recommended by students
Recommended by parents
Respectful managers
Part-time
Medical, Dental, Vision, Retirement, PTO
Posted 23 days ago
Job description
Your experience matters
At Sycamore Springs, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.
What we offer
Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:
- Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
- Competitive Paid Time Off
- Employee Assistance Program - mental, physical, and financial wellness assistance
- Tuition Reimbursement/Assistance for qualified applicants
- And much more...
About Us
People are our passion and purpose. Sycamore Springs is a 48 bed hospital located in Layfette, IN and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone-your experience matters
How you'll contribute
Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers and other payers. UR advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to managed care providers for necessary treatment. UR contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient's stay and assists the treatment team in understanding the insurance company's requirements for continued stay and discharge planning.
Essential Functions:
- Displays knowledge of clinical criteria, managed care requirements for inpatient and outpatient authorization and advocates on behalf of the patient to secure coverage for needed services
- Completes pre and re-certifications for inpatient and outpatient services. Reports appropriate denial, and authorization information to designated resource.
- Actively communicates with interdisciplinary team to acquire pertinent information and give updates on authorizations.
- Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.
- Works with DON to ensure documentation requirements are met.
- Ensure appeals are completed thoroughly and on a timely basis.
- Interface with managed care organizations, external reviews, and other payers.
- Communicate with physicians to schedule peer to peer reviews.
- Accurately report denials.
Qualifications and requirements
Bachelor's Degree
Previous utilization review experience in a psychiatric healthcare facility preferred.
EEOC Statement:
Sycamore Springs is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.
Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.
About LifePoint Health
Sourced by ZipRecruiter
Lifepoint Health serves patients, clinicians, communities and partners across the healthcare continuum. Our diversified healthcare delivery network extends from coast to coast, consisting of community hospitals, rehabilitation and behavioral health hospitals, and additional sites of care.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Brentwood, TN, US
Year founded
1999
Website
What LifePoint Health employees say
Pay
Benefits
Hours and flexibility
Workplace
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