... insurance companies/authorizing entities to ensure initial precertification and continued ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LAPC, LPC, LMSW, LCSW, LPN or RN ...
... insurance companies/authorizing entities to ensure initial precertification and continued ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LAPC, LPC, LMSW, LCSW, LPN or RN ...
... insurance companies/authorizing entities to ensure initial precertification and continued ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LAPC, LPC, LMSW, LCSW, LPN or RN ...
... insurance companies/authorizing entities to ensure initial precertification and continued ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LAPC, LPC, LMSW, LCSW, LPN or RN ...
... insurance companies/authorizing entities to ensure initial precertification and continued ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LAPC, LPC, LMSW, LCSW, LPN or RN ...
... insurance companies/authorizing entities to ensure initial precertification and continued ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LAPC, LPC, LMSW, LCSW, LPN or RN ...
The Director of Utilization Review is r esponsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with ...
The Director of Utilization Review is r esponsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with ...
The Director of Utilization Review is responsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with ...
The Director of Utilization Review is responsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with ...
The Director of Utilization Review is responsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with ...
The Director of Utilization Review is responsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with ...
The Director of Utilization Review is responsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with ...
The Director of Utilization Review is responsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with ...
The Director of Utilization Review is responsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with ...
The Director of Utilization Review is responsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with ...
Travel Utilization Review - $2,250 per week
Atlanta, GA · On-site
$2.2K/wk
Utilization Review * Discipline: Therapy * Start Date: 07/27/2026 * Duration: 13 weeks * 40 hours ... Short-term disability, life insurance, paid jury duty * Access to the largest network of facilities ...
Travel Utilization Review - $2,250 per week
Atlanta, GA · On-site
$2.2K/wk
Utilization Review * Discipline: Therapy * Start Date: 07/27/2026 * Duration: 13 weeks * 40 hours ... Short-term disability, life insurance, paid jury duty * Access to the largest network of facilities ...
Perform the utilization and review process, for continued stay, in an appropriate and timely manner ... insurance offering, a physician network and various related services located all over the U.S ...
Perform the utilization and review process, for continued stay, in an appropriate and timely manner ... insurance offering, a physician network and various related services located all over the U.S ...
Responsibilities Coastal Harbor Health is currently seeking a Utilization Review Coordinator Per ... insurance offering, a physician network and various related services located all over the U.S ...
Responsibilities Coastal Harbor Health is currently seeking a Utilization Review Coordinator Per ... insurance offering, a physician network and various related services located all over the U.S ...
Utilization Specialist
Riverdale, GA · On-site
PURPOSE STATEMENT: Proactively monitor utilization of services for patients to optimize ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Specialist
Riverdale, GA · On-site
PURPOSE STATEMENT: Proactively monitor utilization of services for patients to optimize ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Specialist
Valdosta, GA · On-site
PURPOSE STATEMENT: Proactively monitor utilization of services for patients to optimize ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Specialist
Valdosta, GA · On-site
PURPOSE STATEMENT: Proactively monitor utilization of services for patients to optimize ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Specialist
Valdosta, GA · On-site
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Specialist
Valdosta, GA · On-site
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Specialist
Valdosta, GA · On-site
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Specialist
Valdosta, GA · On-site
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Specialist
Riverdale, GA · On-site
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Specialist
Riverdale, GA · On-site
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Specialist
Riverdale, GA · On-site
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Specialist
Riverdale, GA · On-site
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
The position combines utilization review, care coordination, insurance authorization management, and administrative oversight within behavioral health services. Location/Schedule: 3575 Fulton Mill ...
The position combines utilization review, care coordination, insurance authorization management, and administrative oversight within behavioral health services. Location/Schedule: 3575 Fulton Mill ...
The position combines utilization review, care coordination, insurance authorization management, and administrative oversight within behavioral health services. Location/Schedule: 3575 Fulton Mill ...
The position combines utilization review, care coordination, insurance authorization management, and administrative oversight within behavioral health services. Location/Schedule: 3575 Fulton Mill ...
Insurance Utilization Reviewer information
What are the key skills and qualifications needed to thrive as an Insurance Utilization Reviewer, and why are they important?
To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.
What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?
| Aspect | Insurance Utilization Reviewer | Insurance Claims Processor |
|---|---|---|
| Primary Role | Review medical necessity and appropriateness of services for insurance coverage | Process and review insurance claims for payment and accuracy |
| Required Credentials | Often requires healthcare or insurance certifications, such as RHIT or CPC | Typically requires claims processing or insurance certifications, like CPC or CPC-H |
| Work Environment | Healthcare settings, insurance companies, or third-party administrators | Insurance companies, healthcare providers, or claims processing centers |
| Industry Usage | Commonly employed in health insurance and managed care | Widely used across health, auto, and property insurance sectors |
The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.
What are some common challenges faced by Insurance Utilization Reviewers, and how can they be addressed?
One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.
What are Insurance Utilization Reviewers?
Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.
What are popular job titles related to Insurance Utilization Reviewer jobs in Georgia? For Insurance Utilization Reviewer jobs in Georgia, the most frequently searched job titles are:
- Utilization Management Nurse
- Navihealth Clinical Review Coordinator
- Utilization Review Specialist
- Remote Utilization Management Pharmacist
- Remote Utilization Review Physical Therapist
- Utilization Management
- Remote Cvs Utilization Management Nurse
- Cvs Health Utilization Management
- Optum Health Utilization Review
- Weekend Physician Advisor Utilization Review
What job categories do people searching Insurance Utilization Reviewer jobs in Georgia look for? The top searched job categories for Insurance Utilization Reviewer jobs in Georgia are:
What cities in Georgia are hiring for Insurance Utilization Reviewer jobs? Cities in Georgia with the most Insurance Utilization Reviewer job openings:
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 11 days ago
Universal Health Services rating
6.8
Based on 252 frontline employees who took The Breakroom Quiz
491st of 882 rated healthcare providers
Job description
Responsibilities
Qualifications
Lighthouse Care Center of Augusta has been providing psychiatric services to the CSRA for more than 15-years. Located in Augusta, GA our 84-bed facility provides a therapeutic setting for those seeking treatment for mental illness. Lighthouse Care Center offers unique and individualized programming for adolescents and adults that sets us apart from many other treatment facilities, and our tenured team includes seasoned medical staff.
Website: https://www.LighthouseCareCenters.com
The Utilization Review Coordinator opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care; ensuring that delivery of high-quality and cost-effective treatment is consistent with the mission, vision, and values of Universal Health Services and in accordance with government regulation, licensing and accreditation requirements. Under the direction of the UR Manager, the Utilization Review Coordinator is responsible for conducting clinical review of data to determine eligibility respective to pre-certification and continued stay reviews.
Job Duties/ Responsibilities:
- Review clinical content of medical records, participate in treatment team meetings, and collaborate with physicians, therapist, nurses and pertinent staff on gathering the necessary data to communicate with insurance companies/authorizing entities to ensure initial precertification and continued authorization is achieved.
- Ensure input of pre-certifications and continued stay reviews into Midas, follow-up on unfinished pre-certifications from the day before, coordinate with the treatment team on any follow-ups necessary, verify insurance coverage at the first of the month, and post patient payments into MS4.
- Trained in all aspects relative to timely gathering of clinical criteria, communication of clinical criteria, and entry of supporting clinical criteria into computer based systems, in addition to other job duties.
Benefit Highlights
- Referral Bonus Program
- Challenging and rewarding work environment
- Competitive Compensation & Generous Paid Time Off
- Excellent Medical, Dental, Vision and Prescription Drug Plans
- 401(K) with company match and discounted stock plan
- Career development opportunities within UHS and its 300+ Subsidiaries!
- More information is available on our Benefits Guest Website: uhsguest.com
About Universal Health Services
One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has 99,000 employees. Through its subsidiaries, UHS operates 28 acute care hospitals, 331 behavioral health facilities, 60 outpatient and other facilities in 39 U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.
Qualifications
EDUCATION AND EXPERIENCE
Masters level education in social science field (social work, counseling, sociology, psychology). Must be license-eligible or licensed in Georgia.
Nurses with a current GA or Multistate RN license encouraged to apply.
Must have 2 years of experience in a psychiatric health care setting, delivery of care to psychiatric and/or chemically dependent patients and utilization review.
CERTIFICATIONS, LICENSES, REGISTRATION
LMHC, LAPC, LPC, LMSW, LCSW, LPN or RN preferred.
Qualifications:EDUCATION AND EXPERIENCE
Masters level education in social science field (social work, counseling, sociology, psychology). Must be license-eligible or licensed in Georgia.
Nurses with a current GA or Multistate RN license encouraged to apply.
Must have 2 years of experience in a psychiatric health care setting, delivery of care to psychiatric and/or chemically dependent patients and utilization review.
CERTIFICATIONS, LICENSES, REGISTRATION
LMHC, LAPC, LPC, LMSW, LCSW, LPN or RN preferred.
Education:UNAVAILABLEEmployment Type: FULL_TIMEWhat Universal Health Services employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Universal Health Services
Sourced by ZipRecruiter
Universal Health Services (UHS) is a major player in the healthcare industry, based in King of Prussia, Pennsylvania, U.S. Founded in 1978, UHS offers hospital and healthcare services. Their diverse services range from acute care hospitals, behavioral health facilities and ambulatory centers nationwide. The company's mission of enhancing the health and well-being of their patients is reflected in their commitment to 'Helping Individuals Live Longer, Healthier and Happier Lives'. Universal Health Services' consistent growth and success in their industry have been recognized on numerous occasions, including being ranked amongst the Fortune 500 list of largest companies.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
King of Prussia, PA, US