Assists in utilization reviews and insurance appeals. Responds to inquiries from patients, their ... the chart to supervisor immediately to ensure timely resolution of problems. • Responds to ...
Assists in utilization reviews and insurance appeals. Responds to inquiries from patients, their ... the chart to supervisor immediately to ensure timely resolution of problems. • Responds to ...
Utilization Management Nurse
$34 - $55/hr
Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of ...
Utilization Management Nurse
$34 - $55/hr
Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of ...
Utilization Management Nurse
$34 - $55/hr
Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of ...
Utilization Management Nurse
$34 - $55/hr
Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of ...
... utilization of resources, service delivery, and compliance with medical regime. Essential Duties ... Performs chart review/audits monthly or as needed * Participates in monthly case conferences by ...
New
... utilization of resources, service delivery, and compliance with medical regime. Essential Duties ... Performs chart review/audits monthly or as needed * Participates in monthly case conferences by ...
New
... chart as necessitated by job role or function. Adheres to most current work flows or processes ... Admitting Utilization Review Social Work Managed Care Patient Financial Services and Contracting ...
... chart as necessitated by job role or function. Adheres to most current work flows or processes ... Admitting Utilization Review Social Work Managed Care Patient Financial Services and Contracting ...
... utilization of resources, service delivery, and compliance with medical regime. Essential Duties ... Performs chart review/audits monthly or as needed * Participates in monthly case conferences by ...
New
... utilization of resources, service delivery, and compliance with medical regime. Essential Duties ... Performs chart review/audits monthly or as needed * Participates in monthly case conferences by ...
New
Clinical Program Manager
Washington, DC · On-site
$90K/yr
... utilization review, authorization requests, discharge planning, and coordination with psychiatric ... chart reviews, overseeing program practices, and maintaining compliance with agency policies ...
Quick apply
Clinical Program Manager
Washington, DC · On-site
$90K/yr
... utilization review, authorization requests, discharge planning, and coordination with psychiatric ... chart reviews, overseeing program practices, and maintaining compliance with agency policies ...
Clinical appeals writing, medical record/chart review, and utilization review; Strong clinical foundation with the ability to assess medical necessity and documentation support * Other : Excellent ...
Clinical appeals writing, medical record/chart review, and utilization review; Strong clinical foundation with the ability to assess medical necessity and documentation support * Other : Excellent ...
Performs substantive chart reviews to assure there is evidence that quality care is being delivered. * Participates in the Outcomes Management and annual program review. * Performs utilization review ...
Performs substantive chart reviews to assure there is evidence that quality care is being delivered. * Participates in the Outcomes Management and annual program review. * Performs utilization review ...
Performs substantive chart reviews to assure there is evidence that quality care is being delivered. * Participates in the Outcomes Management and annual program review. * Performs utilization review ...
Performs substantive chart reviews to assure there is evidence that quality care is being delivered. * Participates in the Outcomes Management and annual program review. * Performs utilization review ...
Nurse Administrator
Mclean, VA · On-site
$85K - $100K/yr
Participates in the utilization review process and communicates with the nursing team on related ... Performs chart audits to ensure accuracy and compliance with policy and regulatory requirements.
Nurse Administrator
Mclean, VA · On-site
$85K - $100K/yr
Participates in the utilization review process and communicates with the nursing team on related ... Performs chart audits to ensure accuracy and compliance with policy and regulatory requirements.
Clinical Director Recovery & Wellness
Washington, DC · Hybrid
$100K - $110K/yr
Ensure utilization review processes are followed * Develop performance improvement initiatives ... Conduct regular internal chart audits * Ensure program compliance with federal and District ...
New
Clinical Director Recovery & Wellness
Washington, DC · Hybrid
$100K - $110K/yr
Ensure utilization review processes are followed * Develop performance improvement initiatives ... Conduct regular internal chart audits * Ensure program compliance with federal and District ...
New
Substance Abuse Treatment Program Director
Waldorf, MD · On-site
$95K - $110K/yr
... utilization review and supervision of admission activities to determine appropriate levels of care ... Completes and submits to clinical leadership the required number of active chart reviews as well as ...
Quick apply
Substance Abuse Treatment Program Director
Waldorf, MD · On-site
$95K - $110K/yr
... utilization review and supervision of admission activities to determine appropriate levels of care ... Completes and submits to clinical leadership the required number of active chart reviews as well as ...
... chart, which includes identification of psychosocial factors with high-risk potential, social ... Monitors insurance requirements and keeps utilization reviewer and other treatment team members ...
... chart, which includes identification of psychosocial factors with high-risk potential, social ... Monitors insurance requirements and keeps utilization reviewer and other treatment team members ...
... chart review, data review, and provide guidance to ensure that the quality of care being provided meets appropriate standards and to ensure cost-effective utilization practices for new and current ...
... chart review, data review, and provide guidance to ensure that the quality of care being provided meets appropriate standards and to ensure cost-effective utilization practices for new and current ...
... chart review, data review, and provide guidance to ensure that the quality of care being provided meets appropriate standards and to ensure cost-effective utilization practices for new and current ...
... chart review, data review, and provide guidance to ensure that the quality of care being provided meets appropriate standards and to ensure cost-effective utilization practices for new and current ...
Lead daily clinical huddles to review schedules, staffing, patient needs, safety issues, and ... Quality & Chart Audits: Conduct routine chart audits to ensure documentation quality and regulatory ...
Quick apply
Lead daily clinical huddles to review schedules, staffing, patient needs, safety issues, and ... Quality & Chart Audits: Conduct routine chart audits to ensure documentation quality and regulatory ...
Clinical Pharmacist-Hospital - $10K Sign-on Bonus
Springfield, VA · On-site
$100 - $120/hr
Monitor therapy through chart review, patient profiles, and collaboration with care teams ... Support fiscal stewardship through responsible resource utilization. * Participate in ...
New
Clinical Pharmacist-Hospital - $10K Sign-on Bonus
Springfield, VA · On-site
$100 - $120/hr
Monitor therapy through chart review, patient profiles, and collaboration with care teams ... Support fiscal stewardship through responsible resource utilization. * Participate in ...
New
Associate Medical Director, Med-Psych
Bethesda, MD · On-site
$200 - $250/hr
Conduct in‑depth chart reviews and data analysis to ensure: * Appropriate clinical care plans addressing root causes of avoidable IP/ED utilization and total cost of care * Accurate diagnosis ...
Associate Medical Director, Med-Psych
Bethesda, MD · On-site
$200 - $250/hr
Conduct in‑depth chart reviews and data analysis to ensure: * Appropriate clinical care plans addressing root causes of avoidable IP/ED utilization and total cost of care * Accurate diagnosis ...
Clinical Pharmacist-Hospital Overnights 7 on/7 off - $20K Sign-on Bonus
Springfield, VA · On-site
$110 - $140/hr
Monitor therapy through chart review, patient profiles, and collaboration with care teams ... Support fiscal stewardship through responsible resource utilization. * Participate in ...
New
Clinical Pharmacist-Hospital Overnights 7 on/7 off - $20K Sign-on Bonus
Springfield, VA · On-site
$110 - $140/hr
Monitor therapy through chart review, patient profiles, and collaboration with care teams ... Support fiscal stewardship through responsible resource utilization. * Participate in ...
New
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 Washington?
For Chart Utilization Review jobs in Washington, the most frequently searched job titles are:
- Manager Utilization Management
- Night Utilization Review Nurse
- Weekend Physician Advisor Utilization Review
- Home Based Utilization Review Nurse
- Freelance Utilization Review Nurse
- Independent Contractor Remote Utilization Management Nurse
- Part Time Utilization Review Nurse
- Evening Optum Health Utilization Review
- No Experience Utilization Management Nurse
- Night Shift Remote Utilization Review Nurse
What job categories do people searching Chart Utilization Review jobs in Washington look for?
The top searched job categories for Chart Utilization Review jobs in Washington are:
What cities in Washington are hiring for Chart Utilization Review jobs?
Cities in Washington with the most Chart Utilization Review job openings:
Job description
Utilization Assistant - Acute | Highland Hospital | Charleston, West Virginia
About the Job:
The Utilization Assistant provides support to all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization review information. Works with insurance providers to obtain coverage for patients. Assists in utilization reviews and insurance appeals. Responds to inquiries from patients, their families, and professional referral sources.
Roles and Responsibilities:
• Assists the admissions department with pre-certifications of care. Performs pre and post admission benefit verification with managed care organizations.
• Reviews medical records of patients for appropriateness of level of care at admission and at intervals determined by documentation in medical record.
• Conducts interactive and timely reviews with payers to ensure certification of care.
• Maintains accurate documentation and files as it relates to utilization management.
• Coordinates information and findings with the business office to help recognize or resolve possible payment problems.
• Attends daily treatment team to discuss patient needs and ensure that all disciplines are aware of patient insurance status and needs.
• Ensure that insurance benefits are verified in a timely manner.
• Communicates any UR or Quality issues as noted in the chart to supervisor immediately to ensure timely resolution of problems.
• Responds to telephone and Internet inquires.
• Researches insurance company guidelines and uses admission and continuing stay criteria for coverage.
• High School Diploma Required, Bachelor's Degree in social work, behavioral or mental health, or other related health field preferred.
• One or more years of direct clinical experience in a psychiatric or mental health setting preferred.
Why Highland Hospital?Highland Hospital offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Highland Hospital is an EOE.
Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.
About the Job:
The Utilization Assistant provides support to all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization review information. Works with insurance providers to obtain coverage for patients. Assists in utilization reviews and insurance appeals. Responds to inquiries from patients, their families, and professional referral sources.
Roles and Responsibilities:
• Assists the admissions department with pre-certifications of care. Performs pre and post admission benefit verification with managed care organizations.
• Reviews medical records of patients for appropriateness of level of care at admission and at intervals determined by documentation in medical record.
• Conducts interactive and timely reviews with payers to ensure certification of care.
• Maintains accurate documentation and files as it relates to utilization management.
• Coordinates information and findings with the business office to help recognize or resolve possible payment problems.
• Attends daily treatment team to discuss patient needs and ensure that all disciplines are aware of patient insurance status and needs.
• Ensure that insurance benefits are verified in a timely manner.
• Communicates any UR or Quality issues as noted in the chart to supervisor immediately to ensure timely resolution of problems.
• Responds to telephone and Internet inquires.
• Researches insurance company guidelines and uses admission and continuing stay criteria for coverage.
• High School Diploma Required, Bachelor's Degree in social work, behavioral or mental health, or other related health field preferred.
• One or more years of direct clinical experience in a psychiatric or mental health setting preferred.
Why Highland Hospital?Highland Hospital offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Highland Hospital is an EOE.
Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.
About Summit BHC
Sourced by ZipRecruiter
Summit BHC, based in Franklin, TN, USA, is a recognized leader in the field of addiction treatment and behavioral health care services. The company operates a nationwide network of treatment centers aimed at caring for individuals battling substance abuse and mental health disorders. Summit BHC was established with the mission to provide high-quality, addiction treatment and behavioral health services to those in need throughout the United States. With compassion, dignity, and respect as their core values, they endeavor to instill hope during the journey to recovery and beyond.
Industry
Health care and social assistance
Company size
501 - 1,000 Employees
Headquarters location
Franklin, TN, US
Year founded
2013