Utilization Coordinator
San Juan, PR · On-site
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Employment Type: FULL_TIME
Utilization Coordinator
San Juan, PR · On-site
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Employment Type: FULL_TIME
Utilization Coordinator
San Juan, PR · On-site
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Employment Type: FULL_TIME
Utilization Coordinator
San Juan, PR · On-site
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Employment Type: FULL_TIME
... utilization review processes to assure continuity for the most appropriate level of care for ... Employment Type: FULL_TIME
... utilization review processes to assure continuity for the most appropriate level of care for ... Employment Type: FULL_TIME
Pharmacist Call Center - San Juan, PR
San Juan, PR · On-site
$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
San Juan, PR · On-site
$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 ...
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 ...
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications: Federal experience is ... One year of experience refers to full-time work; part-timework is considered on a prorated basis.
Financial Analyst
Guaynabo, PR · On-site
Investigate and resolve discrepancies related to utilization, eligibility, or payment amounts ... Compile documentation requested during internal or external reviews * Ensure outputs align with ...
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Financial Analyst
Guaynabo, PR · On-site
Investigate and resolve discrepancies related to utilization, eligibility, or payment amounts ... Compile documentation requested during internal or external reviews * Ensure outputs align with ...
Database Administration Sr - Puerto Rico
Aguadilla, PR · On-site
$76K - $142K/yr
Reviews database design and integration of systems, provides backup recovery and makes ... Experience with Jira and Confluence Pay Information Full-Time Salary Range: $76700.00 - $142500.00 ...
Database Administration Sr - Puerto Rico
Aguadilla, PR · On-site
$76K - $142K/yr
Reviews database design and integration of systems, provides backup recovery and makes ... Experience with Jira and Confluence Pay Information Full-Time Salary Range: $76700.00 - $142500.00 ...
Database Administration Sr - Puerto Rico
$76K - $142K/yr
Reviews database design and integration of systems, provides backup recovery and makes ... and utilization. Responsibilities include: database loading; development and management of ...
Database Administration Sr - Puerto Rico
$76K - $142K/yr
Reviews database design and integration of systems, provides backup recovery and makes ... and utilization. Responsibilities include: database loading; development and management of ...
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:
- Remote Utilization Review
- Utilization Review 1099
- Cigna Utilization Review Remote
- Remote Physical Therapy Utilization Review
- Utilization Review Nurse Compact License
- Utilization Review
- Remote Rn Utilization Review Nurse
- Fulltime Cigna Utilization Review Nurse
- Optum Utilization Review Nurse
- Remote Chiropractic 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 22 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