Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Employment Type: FULL_TIME
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Employment Type: FULL_TIME
Pharmacist Call Center - San Juan, PR
$57 - $68.75/hr
... Utilization Review program protocols providing clinical recommendations pertaining to, but not ... Extended hours and occasional weekends may be required as needed Preferred Qualifications: * 1 ...
Pharmacist Call Center - San Juan, PR
$57 - $68.75/hr
... Utilization Review program protocols providing clinical recommendations pertaining to, but not ... Extended hours and occasional weekends may be required as needed Preferred Qualifications: * 1 ...
Case Review Specialist - PR
Guaynabo, PR · On-site
Fax intake and labeling on weekends/Holidays as needed About You * Bachelor's Degree or relevant ... Our Current Solutions Through the use of OncoHealth's utilization management system, OneUM , our ...
Case Review Specialist - PR
Guaynabo, PR · On-site
Fax intake and labeling on weekends/Holidays as needed About You * Bachelor's Degree or relevant ... Our Current Solutions Through the use of OncoHealth's utilization management system, OneUM , our ...
Case Review Specialist - PR
Guaynabo, PR · On-site +1
Fax intake and labeling on weekends/Holidays as needed About You * Bachelor's Degree or relevant ... Our Current Solutions Through the use of OncoHealth's utilization management system, OneUM , our ...
Case Review Specialist - PR
Guaynabo, PR · On-site +1
Fax intake and labeling on weekends/Holidays as needed About You * Bachelor's Degree or relevant ... Our Current Solutions Through the use of OncoHealth's utilization management system, OneUM , our ...
Board Certified Behavior Analyst / BCBA
San Juan, PR · On-site
$85K/yr
Board Certified Behavior Analyst / BCBA ABA Centers of Puerto Rico San Juan, PR / Full Time ... (QA), Utilization Review (UR), Assessments, Training & Development, and Research. Whether your ...
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Board Certified Behavior Analyst / BCBA
San Juan, PR · On-site
$85K/yr
Board Certified Behavior Analyst / BCBA ABA Centers of Puerto Rico San Juan, PR / Full Time ... (QA), Utilization Review (UR), Assessments, Training & Development, and Research. Whether your ...
Process Engineer
Manati, PR · On-site
Defines, analyzes, reviews and evaluates problems for prompt solutions. * Determines, adapts, and ... weekends per the operational needs. * Some traveling may be required. * Functional knowledge of ...
Process Engineer
Manati, PR · On-site
Defines, analyzes, reviews and evaluates problems for prompt solutions. * Determines, adapts, and ... weekends per the operational needs. * Some traveling may be required. * Functional knowledge of ...
PR · On-site
... utilization of employees within an organization. The primary goal of this role is to ensure the ... Occasional availability to work weekends and holidays may be required based on operational needs.
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Process Engineer
Manati, PR · On-site
Defines, analyzes, reviews and evaluates problems for prompt solutions. * Determines, adapts, and ... weekends per the operational needs. * Some traveling may be required. * Functional knowledge of ...
Process Engineer
Manati, PR · On-site
Defines, analyzes, reviews and evaluates problems for prompt solutions. * Determines, adapts, and ... weekends per the operational needs. * Some traveling may be required. * Functional knowledge of ...
PR · On-site
... utilization of employees within an organization. The primary goal of this role is to ensure the ... Occasional availability to work weekends and holidays may be required based on operational needs.
Quick apply
PR · On-site
... utilization of employees within an organization. The primary goal of this role is to ensure the ... Occasional availability to work weekends and holidays may be required based on operational needs.
Quick apply
PR · On-site
... utilization of employees within an organization. The primary goal of this role is to ensure the ... Occasional availability to work weekends and holidays may be required based on operational needs.
Quick apply
Program Manager
Caguas, PR · On-site
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Program Manager
Caguas, PR · On-site
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Program Manager
Mayaguez, PR · On-site
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Program Manager
Mayaguez, PR · On-site
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Program Manager
San Juan, PR · On-site
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Program Manager
San Juan, PR · On-site
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Lead Project ManagerFederal Contract Support San Juan, PR | Full-Time Contract | On-Site Position ... Track program budgets, expenditures, and resource utilization * Monitor cost performance and ...
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Lead Project ManagerFederal Contract Support San Juan, PR | Full-Time Contract | On-Site Position ... Track program budgets, expenditures, and resource utilization * Monitor cost performance and ...
Program Manager
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Program Manager
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Program Manager
Mayaguez, PR · On-site
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Program Manager
Mayaguez, PR · On-site
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Program Manager
Caguas, PR · On-site
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Program Manager
Caguas, PR · On-site
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Program Manager
Guaynabo, PR · On-site
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Program Manager
Guaynabo, PR · On-site
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Program Manager
Guaynabo, PR · On-site
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Program Manager
Guaynabo, PR · On-site
$125K/yr
LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Full Time Weekend Utilization Review information
What is the difference between Full Time Weekend Utilization Review vs Full Time Weekday Utilization Review?
| Aspect | Full Time Weekend Utilization Review | Full Time Weekday Utilization Review |
|---|---|---|
| Work Schedule | Primarily weekends and possibly some evenings | Primarily weekdays, Monday to Friday |
| Certifications | Typically requires medical or insurance-related certifications | Same certifications as weekend roles, often the same qualifications |
| Work Environment | Remote or office-based, with flexible hours on weekends | Standard office hours during weekdays |
| Employer & Industry | Healthcare insurance companies, utilization review organizations | Same industry, different scheduling focus |
Full Time Weekend Utilization Review roles focus on reviewing cases during weekends, offering flexibility for those who prefer weekend work. Full Time Weekday Utilization Review positions operate during standard business hours on weekdays. Both roles require similar certifications and work in the same industry, but differ mainly in scheduling and work hours.
What are popular job titles related to Full Time Weekend Utilization Review jobs in Puerto Rico?
For Full Time Weekend Utilization Review jobs in Puerto Rico, the most frequently searched job titles are:
What job categories do people searching Full Time Weekend Utilization Review jobs in Puerto Rico look for?
The top searched job categories for Full Time Weekend Utilization Review jobs in Puerto Rico are:
- Utilization Review Nurse Compact License
- Remote Utilization Review
- Utilization Review
- Optum Utilization Review Nurse
- Remote Physical Therapy Utilization Review
- Full Time Cigna Utilization Review Nurse
- Volunteer Aetna Utilization Review Nurse
- Fulltime Cigna Utilization Review Nurse
- Temporary Medical Utilization Review Physician
- Remote Optum Utilization Review
What cities in Puerto Rico are hiring for Full Time Weekend Utilization Review jobs?
Cities in Puerto Rico with the most Full Time Weekend Utilization Review job openings:
Full-time
Re-posted 2 days ago
Job description
Overview
PURPOSE STATEMENT:
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
ResponsibilitiesESSENTIAL FUNCTIONS:
- Act as liaison between managed care organizations and the facility professional clinical staff.
- Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
- Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
- Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
- Conduct quality reviews for medical necessity and services provided.
- Facilitate peer review calls between facility and external organizations.
- Initiate and complete the formal appeal process for denied admissions or continued stay.
- Assist the admissions department with pre-certifications of care.
- Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
OTHER FUNCTIONS:
- Perform other functions and tasks as assigned.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- Required Education: High school diploma or equivalent.
- Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
- Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
- CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
- First aid may be required based on state or facility requirements.
ADDITIONAL REGULATORY REQUIREMENTS:
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.
Employment Type: FULL_TIME