Monday-Friday (8:00am-4:30pm) Position is work from home after a 90 day in-office training period ... Conducts utilization reviews of behavioral health cases to determine medical necessity ...
Monday-Friday (8:00am-4:30pm) Position is work from home after a 90 day in-office training period ... Conducts utilization reviews of behavioral health cases to determine medical necessity ...
Monday-Friday (8:00am-4:30pm) Position is work from home after a 90 day in-office training period ... Conducts utilization reviews of behavioral health cases to determine medical necessity ...
Monday-Friday (8:00am-4:30pm) Position is work from home after a 90 day in-office training period ... Conducts utilization reviews of behavioral health cases to determine medical necessity ...
Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ... Highly desired If you have any questions, please feel free to call us directly at 212-219-2677 and ...
Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ... Highly desired If you have any questions, please feel free to call us directly at 212-219-2677 and ...
Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free ... Training & Support: Training programs and ongoing career coaching and support is offered to ...
Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free ... Training & Support: Training programs and ongoing career coaching and support is offered to ...
Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free ... Training & Support: Training programs and ongoing career coaching and support is offered to ...
Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free ... Training & Support: Training programs and ongoing career coaching and support is offered to ...
Monitors and reviews MCO portals to track authorization status, pending requests, approvals ... Participates in department meetings, training, and process improvement initiatives. * Performs ...
Monitors and reviews MCO portals to track authorization status, pending requests, approvals ... Participates in department meetings, training, and process improvement initiatives. * Performs ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Utilization Management Rep I
Mason, OH · On-site
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Utilization Management Rep I
Mason, OH · On-site
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Utilization Management Rep I
Mason, OH · On-site
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Utilization Management Rep I
Mason, OH · On-site
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Director Utilization Review directs the department's activities and resources to ensure alignment ... Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing ...
Director Utilization Review directs the department's activities and resources to ensure alignment ... Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing ...
Utilization Management Rep I
Mason, OH · On-site
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Utilization Management Rep I
Mason, OH · On-site
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
Assistant manager in Training /Motion Specialist
Woodmere, OH · On-site
$15 - $22/hr
Training & development Why Work for InMotion Wellness Studio: * Hourly pay plus bonuses based on ... Free utilization of our stretching program. * Work/life balance : Depending on client needs, your ...
Assistant manager in Training /Motion Specialist
Woodmere, OH · On-site
$15 - $22/hr
Training & development Why Work for InMotion Wellness Studio: * Hourly pay plus bonuses based on ... Free utilization of our stretching program. * Work/life balance : Depending on client needs, your ...
Registered Nurse / RN - Utilization Review
Cleveland, OH · On-site
$2.3K/wk
Additionally, you are offered access to dental and vision coverage, commuter benefits, a 401(k) plan, flexible spending, referral bonuses, ongoing training, and more. As an ESOP company, Solomon Page ...
Registered Nurse / RN - Utilization Review
Cleveland, OH · On-site
$2.3K/wk
Additionally, you are offered access to dental and vision coverage, commuter benefits, a 401(k) plan, flexible spending, referral bonuses, ongoing training, and more. As an ESOP company, Solomon Page ...
Care Review Processor
Columbus, OH · On-site
Training: Onsite classroom style training for 3 weeks. * Expectation after training is to handle 20 ... utilization review for other healthcare services * Checks eligibility and verifies benefits ...
Care Review Processor
Columbus, OH · On-site
Training: Onsite classroom style training for 3 weeks. * Expectation after training is to handle 20 ... utilization review for other healthcare services * Checks eligibility and verifies benefits ...
Directs education, training, and auditing of all clinical services and operational staff ... review process including leading clinical meetings to facilitate relationship building and ...
Directs education, training, and auditing of all clinical services and operational staff ... review process including leading clinical meetings to facilitate relationship building and ...
Free Utilization Review Training information
What is free utilization review training?
Free utilization review training refers to educational programs or courses that teach individuals the fundamentals of utilization review without requiring payment. Utilization review is a process used in healthcare to assess the necessity, efficiency, and appropriateness of medical services, procedures, or admissions. These free training options are often available online and can help nurses, case managers, or other healthcare professionals gain the skills needed to pursue roles in utilization management. Training typically covers topics such as clinical guidelines, insurance protocols, and regulatory compliance. Completing such training can enhance career opportunities in healthcare case management and insurance settings.
What are the key skills and qualifications needed to thrive as a utilization review nurse, and why are they important?
To thrive as a Utilization Review Nurse, you need a current RN license, strong clinical assessment skills, and knowledge of insurance and healthcare regulations. Familiarity with utilization management software, electronic health records (EHRs), and possibly certifications like Certified Utilization Review Nurse (CURN) are typically expected. Excellent communication, analytical thinking, and attention to detail are standout soft skills in this position. These abilities are crucial for ensuring appropriate patient care, compliance, and cost-effective healthcare delivery.
What are some common challenges faced by professionals during utilization review training, and how can they be overcome?
During utilization review training, professionals often encounter challenges such as adapting to complex healthcare regulations, learning to interpret medical records efficiently, and effectively applying clinical guidelines to decision-making. Overcoming these challenges requires strong attention to detail, ongoing engagement with training modules, and seeking mentorship from experienced utilization review nurses or case managers. Actively participating in case discussions and staying updated with industry standards can also help trainees build confidence and competence for a successful career in utilization review.
What is the difference between Free Utilization Review Training vs Utilization Review Nurse?
| Aspect | Free Utilization Review Training | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically no formal credentials required; focus on training programs | Registered Nurse (RN) license required, with possible certifications like CCM or UR-specific credentials |
| Work Environment | Training sessions, online courses, workshops | Hospitals, insurance companies, healthcare facilities |
| Employer & Industry Usage | Used for skill development and certification prep | Performing reviews, making coverage decisions, ensuring appropriate care |
Free Utilization Review Training provides foundational knowledge and skills for those interested in entering or advancing in utilization review roles. In contrast, a Utilization Review Nurse is a licensed healthcare professional actively performing review duties in clinical settings. The training is often a prerequisite or supplement to the nurse's practical work, which requires licensure and clinical experience.
How to become a free utilization review training?
To pursue free utilization review training, individuals can seek online courses, webinars, or workshops offered by healthcare organizations or professional associations. Gaining knowledge of medical terminology, insurance processes, and review protocols is essential, and some programs may require prior healthcare experience or certification in related fields.
What are popular job titles related to Free Utilization Review Training jobs in Ohio?
For Free Utilization Review Training jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Free Utilization Review Training jobs in Ohio look for?
The top searched job categories for Free Utilization Review Training jobs in Ohio are:
What cities in Ohio are hiring for Free Utilization Review Training jobs?
Cities in Ohio with the most Free Utilization Review Training job openings:
Utilization Review Specialist - Autism
Hybrid
Nationwide Children's Hospital •
Hospitals • 10K+ employees10,000+ employees
6.9
Based on 131 frontline employees who took The Breakroom Quiz
551st of 1,064 rated hospitals
People enjoy working here
Recommended by students
Respectful managers
Good training
Full-time
Re-posted 6 days ago
Job description
Overview:
Schedule: Monday-Friday (8:00am-4:30pm)
Position is work from home after a 90 day in-office training period.
Job Description Summary:
Job Description:
Essential Functions:
- Conducts utilization reviews of behavioral health cases to determine medical necessity, appropriateness of care, and adherence to clinical guidelines.
- Communicates with healthcare teams and third-party payors to ensure the delivery of quality care and optimum payment.
- Assists with retrospective reviews and denial management to maintain appropriate and cost-effective patient care.
- Documents all case reviews and maintains accurate records of all clinical activities and coverage information.
- Provides education and support regarding utilization review and management activities and processes.
- Analyzes clinical data to identify trends and patterns that may impact patient care. Participates in quality improvement initiatives to enhance the overall delivery of behavioral health services.
- Facilitates reimbursement by communicating with payers, other staff, patients, and families concerning status of funding and required actions.
Education Requirement:
Bachelor's Degree in Social Work, Psychology, or related field, or equivalent education and experience, required
Licensure Requirement:
(not specified)
Certifications:
(not specified)
Skills:
- Excellent written and verbal communication and interpersonal skills.
- Excellent customer service and organizational skills.
- Working knowledge of CMS and other review agency standards.
- Proficient with software applications including CM, payer web applications, MITS, and others.
Experience:
- Three years of behavioral health experience, required.
- One year of experience in pediatric care or services, required.
- Utilization review or utilization management experience, preferred.
Physical Requirements:
OCCASIONALLY: Bend/twist, Climb stairs/ladder, Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Reaching above shoulder, Squat/kneel
FREQUENTLY: Standing, Walking
CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing - Far/near, Sitting
Additional Physical Requirements performed but not listed above:
(not specified)
"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
About Nationwide Children's Hospital
Sourced by ZipRecruiter
Nationwide Children's Hospital, established in 1894, is a leading pediatric healthcare system based in Columbus, Ohio, United States. They serve as a primary pediatric network, providing wellness, preventive, diagnostic, treatment, and rehabilitative care for infants, children, adolescents, and adults with congenital disease. Being the third-largest pediatric hospital in the nation, Nationwide Children's Hospital prides itself on its relentless commitment to children and their families, driven by their core values of respect, integrity, determination, empathy, and solidarity. The institution's comprehensive mission is to enhance the health of children by providing high-quality, family-centered care, conducting groundbreaking research, advocating for pediatric health, and training top healthcare professionals.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Columbus, OH, US
Year founded
1892
Website
What Nationwide Children's Hospital employees say
Pay
Benefits
Hours and flexibility
Workplace
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