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Insurance Utilization Reviewer Jobs in Oklahoma (NOW HIRING)

PARKSIDE INC

Utilization Review Specialist

Tulsa, OK · On-site

The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to ... Company Paid Life Insurance and Disability and more! We are an Equal Opportunity Employer!

UHS

UR Coordinator

Oklahoma City, OK · On-site

Serves as liaison for patients and facility with insurance companies. Negotiates and advocates for patient length of stay and level of care. Coordinates utilization review activities with other ...

ScionHealth

Case Manager II - PRN Days

Broken Arrow, OK · On-site

$19 - $25/hr

Knowledge of Medicare benefits and insurance processes and contracts. * Knowledge of accreditation ... Experience in case management, utilization review, or discharge planning a plus.

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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?

AspectInsurance Utilization ReviewerInsurance Claims Processor
Primary RoleReview medical necessity and appropriateness of services for insurance coverageProcess and review insurance claims for payment and accuracy
Required CredentialsOften requires healthcare or insurance certifications, such as RHIT or CPCTypically requires claims processing or insurance certifications, like CPC or CPC-H
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or claims processing centers
Industry UsageCommonly employed in health insurance and managed careWidely 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 Oklahoma? For Insurance Utilization Reviewer jobs in Oklahoma, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Reviewer jobs in Oklahoma look for? The top searched job categories for Insurance Utilization Reviewer jobs in Oklahoma are:
What cities in Oklahoma are hiring for Insurance Utilization Reviewer jobs? Cities in Oklahoma with the most Insurance Utilization Reviewer job openings:
Insurance Utilization Reviewer jobs near you

Utilization Review Specialist

PARKSIDE INC

Tulsa, OK • On-site

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 23 days ago

Job description

Parkside provides professional purpose, hope, and healing. As a member of our staff, you will be part of a mission-driven team, dedicated to changing lives and changing communities, one patient at a time.
Parkside Psychiatric Hospital & Outpatient Clinic is a comprehensive mental healthcare system providing acute inpatient care, residential treatment, and outpatient therapy. With a focus on society's most vulnerable population, Parkside provides world-class mental health services for youth and adults. For over 65 years, Parkside's physicians, therapists, and staff have provided state of the art, patient-centered care that propels families from hopeful to hope-filled. As a center of excellence, we cultivate talent and provide professional purpose. Together we facilitate healing, one patient at a time.
We are looking for a Full Time Utilization Review Specialist! The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private insurance. Coordinates with clinicians, business office and medical records to achieve above goals.
Responsibilities:
• Prepares authorization paperwork, processes requests for authorizations, and reviews requests for accuracy.
• Communicates with clinicians regarding discharge issues relevant to patient's pay source. Tracks due dates for authorization reviews and alerts clinicians.
• Communicates with clinicians regarding admissions and discharges to various units.
• Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage. Maintains current knowledge of managed care requirements and accurately interprets these requirements to increase authorizations.
• Coordinates/completes the appeal process for authorization denials
• Performs audits of clinical services to ensure compliance with standards of third party pay sources and agency policies.
• Tracks unauthorized services and possible recoupment issues. Looks for possible corrections, trends.
• Maintains a good working relationship within the department and with other departments.
• Documentation meets current standards and policies.
• Maintains fit for duty. Acts in a professional manner and follows all Parkside policies and procedures.
• Orients new staff members to the unit
• Demonstrates the ability to be organized and flexible, acts appropriately in stressful/emergency situations. Able to provide Handle with Care when needed
• Performs other duties as assigned
  • Bachelor's degree in related field from an accredited university required. Experience in lieu of Degree will be considered.
  • 2yrs minimal experience in health care, utilization review and business setting

Benefits include:
  • Medical, Dental, and Vision
  • Generous Paid Time Off and Holidays
  • 401K and match start immediately, and includes a generous match
  • Company Paid Life Insurance and Disability and more!

We are an Equal Opportunity Employer!

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