Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Quick apply
Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Quick apply
Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Board-Certified ENT
Lafayette, LA · On-site
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Quick apply
Board-Certified ENT
Lafayette, LA · On-site
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Board-Certified ENT
Lafayette, LA · On-site
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Board-Certified ENT
Lafayette, LA · On-site
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Board-Certified ENT
Lafayette, LA · On-site
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Board-Certified ENT
Lafayette, LA · On-site
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Board-Certified ENT
Lafayette, LA · On-site
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Board-Certified ENT
Lafayette, LA · On-site
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Knowledge of medical billing, insurance verification, pre-certification, prior authorization, and utilization-review processes. * Familiarity with project-management tools and software.
New
Knowledge of medical billing, insurance verification, pre-certification, prior authorization, and utilization-review processes. * Familiarity with project-management tools and software.
New
Knowledge of medical billing, insurance verification, pre-certification, prior authorization, and utilization-review processes. * Familiarity with project-management tools and software.
New
Knowledge of medical billing, insurance verification, pre-certification, prior authorization, and utilization-review processes. * Familiarity with project-management tools and software.
New
Knowledge of medical billing, insurance verification, pre-certification, prior authorization, and utilization-review processes. * Familiarity with project-management tools and software.
New
Knowledge of medical billing, insurance verification, pre-certification, prior authorization, and utilization-review processes. * Familiarity with project-management tools and software.
New
Field Medical Director, Vascular Surgeon
Baton Rouge, LA · On-site
$130 - $140/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... insurance benefits) to qualifying employees. All compensation determinations are based on the ...
Field Medical Director, Vascular Surgeon
Baton Rouge, LA · On-site
$130 - $140/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... insurance benefits) to qualifying employees. All compensation determinations are based on the ...
RN - Admissions - Bonus
La Place, LA · On-site
$42/hr
... utilization review processes to assure continuity for the most appropriate level of care for ... Perform insurance benefit verifications and secure initial pre-authorization for treatment and ...
RN - Admissions - Bonus
La Place, LA · On-site
$42/hr
... utilization review processes to assure continuity for the most appropriate level of care for ... Perform insurance benefit verifications and secure initial pre-authorization for treatment and ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Insurance Utilization Reviewer information
What is an insurance utilization reviewer?
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 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 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 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 popular job titles related to Insurance Utilization Reviewer jobs in Louisiana?
For Insurance Utilization Reviewer jobs in Louisiana, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Reviewer jobs in Louisiana look for?
The top searched job categories for Insurance Utilization Reviewer jobs in Louisiana are:
- Utilization Review Case Manager
- Overnight Remote Utilization Review
- Remote Aetna Utilization Review
- Remote Chiropractic Utilization Review
- Work From Home Utilization Review
- Lpn Utilization Review Nurse
- Seasonal Remote Utilization Review
- Volunteer Aetna Utilization Review Nurse
- Utilization Review Coordinator Remote
- Temporary Aetna Utilization Review Nurse
What cities in Louisiana are hiring for Insurance Utilization Reviewer jobs?
Cities in Louisiana with the most Insurance Utilization Reviewer job openings:
Other
Re-posted 19 days ago
Job description
We are expanding our physician panel for Longshore and Harbor Workers’ Compensation Act (LHWCA) cases and are seeking experienced Psychiatrists to perform:
- Independent Medical Examinations (IMEs)
- Peer Reviews
- Or both
Primary demand is within a 50-mile range of Lake Charles, Louisiana, particularly in Psychiatry.
This is an independent contractor opportunity offering flexible, case-based assignments.
Responsibilities- Conduct in-person, objective, defensible IMEs for Longshore cases
- Perform comprehensive peer reviews of medical records
- Provide detailed, timely written reports
- Maintain compliance with LHWCA standards and documentation requirements
Requirements
- Active, unrestricted Louisiana state medical license
- US Board-certified or board-eligible in Psychiatry
- Must be AMA 6th Edition Certified (or willing to become certified)
- Prior Longshore IME and/or Peer Review experience strongly preferred but not required
- Strong analytical and report-writing skills
- Ability to manage case timelines independently
- Experience performing 30+ Longshore IMEs and/or Peer Reviews
- Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors
- Multi-state Longshore case experience
Benefits
- Opportunity for supplemental income
- Schedule flexibility and predictable work hours-conduct exams and reviews based on your schedule availability
- No doctor/patient relationship is established, and no treatment is provided. These are advisory-only opinions.
- Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise
- Expanded credentials as an expert in Independent Medical Exams
- Fully prepped cases, streamlined case flow, transcription services at no cost, and a user-friendly work portal
About Dane Street
Sourced by ZipRecruiter
Company size
51 - 200 Employees
Headquarters location
Boston, MA, US
Year founded
2008