Must have vast knowledge of medical terminology for accuracy in chart review. attention to detail ... Coordinates with utilization review for authorization status to avoid financial risk Updates ...
Must have vast knowledge of medical terminology for accuracy in chart review. attention to detail ... Coordinates with utilization review for authorization status to avoid financial risk Updates ...
Must have vast knowledge of medical terminology for accuracy in chart review. attention to detail ... Coordinates with utilization review for authorization status to avoid financial risk Updates ...
Must have vast knowledge of medical terminology for accuracy in chart review. attention to detail ... Coordinates with utilization review for authorization status to avoid financial risk Updates ...
Must have vast knowledge of medical terminology for accuracy in chart review. attention to detail ... Coordinates with utilization review for authorization status to avoid financial risk Updates ...
Must have vast knowledge of medical terminology for accuracy in chart review. attention to detail ... Coordinates with utilization review for authorization status to avoid financial risk Updates ...
Must have vast knowledge of medical terminology for accuracy in chart review. attention to detail ... Coordinates with utilization review for authorization status to avoid financial risk Updates ...
Must have vast knowledge of medical terminology for accuracy in chart review. attention to detail ... Coordinates with utilization review for authorization status to avoid financial risk Updates ...
Medical Director/CMO
Dayton, OH · On-site
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
Medical Director/CMO
Dayton, OH · On-site
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
Medical Director/CMO
Dayton, OH · On-site
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
Medical Director/CMO
Dayton, OH · On-site
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
Quick apply
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
Quick apply
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
Quick apply
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
Medical Director/CMO
Dayton, OH · On-site
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
Medical Director/CMO
Dayton, OH · On-site
... utilization review, access metrics, and performance-based incentive programs. * Ensures providers ... Oversees provider peer review, chart audits, and performance evaluations to ensure compliance with ...
Chart Utilization Review information
What is chart utilization review?
Chart Utilization Review is a process commonly used in healthcare settings to assess the necessity, appropriateness, and efficiency of medical services provided to patients. It involves reviewing patient charts and medical records to ensure that treatments and procedures are justified according to established guidelines and policies. This process helps in improving patient care, managing costs, and ensuring compliance with regulatory requirements. Utilization review professionals work closely with medical staff, insurance companies, and regulatory agencies to support quality and cost-effective care.
What are some common challenges faced by professionals in chart utilization review, and how can they be addressed?
Professionals in Chart Utilization Review often encounter challenges such as navigating incomplete or inconsistent medical documentation, staying current with ever-evolving healthcare regulations, and balancing productivity with accuracy. To address these challenges, it is important to maintain open communication with clinical staff, participate in ongoing training, and utilize robust electronic health record systems. Additionally, collaborating closely with interdisciplinary teams can help clarify documentation and ensure compliance with regulatory standards.
What are the key skills and qualifications needed to thrive as a chart utilization review specialist, and why are they important?
To thrive as a Chart Utilization Review specialist, you need a background in healthcare, strong knowledge of medical terminology, and experience with patient care documentation, often supported by an RN or LPN license. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Professional in Utilization Review (CPUR) are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for accurately reviewing charts and collaborating with healthcare providers. These abilities ensure compliance, optimize patient care, and support cost-effective healthcare delivery.
What is the difference between Chart Utilization Review vs Chart Review Specialist?
| Aspect | Chart Utilization Review | Chart Review Specialist |
|---|---|---|
| Credentials | Typically requires healthcare or insurance-related certifications | Often requires medical or coding certifications |
| Work Environment | Healthcare facilities, insurance companies, utilization management teams | Medical offices, insurance companies, coding firms |
| Employer & Industry | Hospitals, insurance providers, healthcare organizations | Medical billing companies, insurance firms, healthcare providers |
| Primary Focus | Assessing medical necessity and appropriateness of services | Reviewing medical records for coding accuracy and completeness |
While both roles involve reviewing medical information, Chart Utilization Review focuses on evaluating the necessity of healthcare services, whereas Chart Review Specialists primarily verify medical documentation for coding and billing accuracy. Understanding these distinctions helps professionals choose the right career path or job search focus.
What are popular job titles related to Chart Utilization Review jobs in Ohio?
For Chart Utilization Review jobs in Ohio, the most frequently searched job titles are:
- Per Diem Remote Chart Review Nurse
- No Experience Utilization Management Nurse
- Independent Contractor Remote Utilization Management Nurse
- Remote Utilization Review Social Worker
- Part Time Utilization Review Nurse
- Per Diem Chart Review Nurse
- Per Diem Utilization Review Nurse
- Overnight Utilization Review Nurse
- Evening Utilization Review Nurse
- Night Utilization Review Nurse
What job categories do people searching Chart Utilization Review jobs in Ohio look for?
The top searched job categories for Chart Utilization Review jobs in Ohio are:
- Temporary Aetna Utilization Review Nurse
- Milliman
- Cigna Utilization Review Nurse
- Night Shift Optum Utilization Review
- Remote Optum Utilization Review
- Authorization Utilization Review
- Per Diem Remote Occupational Therapy Utilization Review
- Behavioral Utilization Review
- Utilization Review Case Manager
- Remote Navihealth Utilization Review
What cities in Ohio are hiring for Chart Utilization Review jobs?
Cities in Ohio with the most Chart Utilization Review job openings:
Physician Services Specialist, Orthopaedics, Various FTE Available
Cincinnati, OH
UC Health •
Hospitals • 10K+ employees10,000+ employees
6.9
Based on 147 frontline employees who took The Breakroom Quiz
459th of 895 rated healthcare providers
People enjoy working here
Recommended by students
Recommended by parents
Respectful managers
Full-time
Posted 21 days ago
Job description
This position will serve as an ambassador of care for patients before and after a patient visits, as well as before and after surgical procedures performed in clinic and the OR. The position will work as a resource to help support clinics and providers. The expectation from this position is that it will support and assist in departmental workflows, processes, and procedures to maintain departmental consistency and ensure patient satisfaction throughout the clinic and OR.
Qualifications
Minimum Required: High School Diploma or GED.
LICENSE & CERTIFICATION: N/A.
Minimum Required: 1 - 2 Years equivalent experience.
Must have vast knowledge of medical terminology for accuracy in chart review. attention to detail, ability to navigate the medical record, great organization, excellent customer service, and self-starting.
Administration:
Answers telephone and direct to correct person if needed.
Manages Outlook Calendar for providers within the clinic.
Manages office incoming mail.
Manages incoming communication related to case authorization.
Validates registration information with patients and verifies all third-party payors (i.e. BWC, accident insurance, etc).
Engages in population appropriate communication.
Gives clear instructions to patients/family regarding treatment, diagnostic, procedural or surgical plan as directed by clinical team.
Monitors and coordinates timely follow up for planned diagnostic procedure based upon the standard of care.
Prepares for upcoming clinics related to procedural planning.
Coordinate clinic template changes required to meet case and procedural obligations.
Coordinates provider calendar related to faculty obligations.
Performs in-basket management tasks.
Coordinates completion of FMLA, Disability, BWC forms.
Scheduling:
Schedules and coordinates patient services, surgeries, tests, and other procedures as needed.
Coordinates all pre-procedural testing, diagnostic studies, medications, and other services as needed.
Communicates with patients via phone and in person regarding scheduling related matters.
Manages OR block time with providers Outlook calendar if applicable based on department guidelines.
Reviews and coordinate case changes identified with leadership related to urgency, case order, or unforeseen delays.
Helps review daily schedules as needed and make leadership aware if changes are needed or discrepancies are identified.
Liaisons between staff and procedural areas for scheduling needs
Coordinates with all product or device representatives for cases
Completes complex coordination with co-surgeons in other surgical practices for joint case authorization and scheduling.
Completes case request and referral order entry.
Data Management:
Performs audits on patient records/registration for insurance billing and compliance.
Reviews of office notes to ensure that all required items are noted for authorization request.
Performs pre-authorizations and pre-certifications utilizing care management protocols.
Utilizes payer portals to complete case, procedure, and visit authorizations.
Coordinates peer to peer reviews for pending case authorization.
Obtains CPT codes for all surgical and procedural cases and submit for authorization.
Obtains retro authorizations as needed.
Coordinates with utilization review for authorization status to avoid financial risk
Updates documentation in referral tab with all authorization updates
Other duties as assigned
About UC Health
Sourced by ZipRecruiter
We believe in something different: a focus on the individuality of every person. In big ways and small, we exist to improve the extraordinary lives of all those we serve. As Colorado's largest and most innovative health care system, we as a team deliver on the commitment to provide the best possible experience for our patients and their families. We foster a true human connection and give people the freedom to live extraordinary lives. A career at UCHealth is more than a job, it's a passion.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Cincinnati, OH, US
Website
What UC Health (Cincinnati) employees say
Pay
Benefits
Hours and flexibility
Workplace
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