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Insurance Utilization Reviewer Jobs in Utah (NOW HIRING)

Imh

Manager Utilization and Care Management

Murray, UT · On-site +1

$44.99 - $69.44/hr

The Clinical Manager at Select Health leads and supervises a team of Utilization Review and Care Management clinicians within an insurance and managed care environment. This role ensures delivery of ...

Aldridge Pite LLP

Title Reviewer

Orem, UT · On-site

Aldridge Pite, LLP is a multi-state law firm that focuses heavily on the utilization of technology ... Company Paid Life and Disability Insurance plans * Medical, Dental and Vision Plans with ...

Aston Carter

Medical Coder - Remote

Salt Lake City, UT · On-site +1

$75/hr

Experience in utilization review, case management, prior authorization, or revenue cycle functions ... Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term ...

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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?

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 popular job titles related to Insurance Utilization Reviewer jobs in Utah?

For Insurance Utilization Reviewer jobs in Utah, the most frequently searched job titles are:

What job categories do people searching Insurance Utilization Reviewer jobs in Utah look for?

The top searched job categories for Insurance Utilization Reviewer jobs in Utah are:

Insurance Utilization Reviewer jobs near you

Utilization Review Therapist

Odyssey House Inc.

Millcreek, UT • On-site

Full-time, Part-time

Medical, Dental, Vision, Retirement, PTO

Posted 8 days ago

Job description

Description


Odyssey House is looking for a Full-Time Utilization Review Specialist.


Summary: Odyssey House's Mission is "Empowering people to heal and build better lives. We are dedicated to helping individuals and families reclaim their lives through effective substance use treatment, medical care, prevention, and mental health services. Odyssey House continues to receive Best of State awards for our clinical work and has received Top Workplace Awards. Join our amazing team of healthcare professionals today!


Full-Time Benefits:

  • $9k per year tuition eligible
  • Access to 24/7 EAP program (Employee Assistance Program) for Mental Health support and more!
  • Opportunities for paid continuing education/training
  • Monthly incentives and awards
  • Flexible scheduling
  • Casual dress and atmosphere
  • Opportunities for bonuses, awards, raises, and promotions
  • Incredible health insurance (medical, dental, vision, FSA, long and short-term disability)
  • Immediate eligibility to participate in our 403(b)-retirement plan, Employer 100% match up to 5% after 1 year 
  • 35 paid days off (additional PTO accrual after 1 year)
  • EXTRA time off and gift packages for PT and FT staff that stay more than 90 days! 
  • Sabbatical Program - where we pay you to take a vacation after 5 years of service! 
  • On-Demand Pay - Get a portion of your paycheck early for hours already worked! (conditions apply)
  • UTA free passes available for your work commute 


Functions of the Job:

  • Track UCE/UR/Insurance Due Dates for all funding and ensure timely submission of all requests.
  • Review all UR submissions for medical necessity, make corrections to UR, and submit for approval.
  • Provide ongoing training to staff regarding writing to medical necessity or other issues that present during reviewing UMs.
  • Resolve funding denials through immediate UR modification and resubmission to minimize loss of days.
  • Update Best Notes and UWITS, as needed, to reflect authorized days.
  • Generate Reports with due dates, notify staff of changes, and manage staff progress.
  • Complete monthly Medicaid check (upload snapshots to Best Notes.)
  • Complete "doc-to-doc" calls, as needed, for insurance authorization.
  • Communicate with OH billing department to resolve issues.
  • Complete all responsibilities in a timely, thorough, and professional manner.
  • Demonstrate fluency in ASAM and DSM-V through successful authorization and processing of UMs.
  • Other Duties as assigned.

Requirements


Licensure / Education / Prior Experience Required:

  • Licensed Mental Health Professional, including - CSW, LCSW, CMHC, ACHMC, LMFT, MFTI. 
  • Graduate degree in the mental health field.
  • Willingness and ability to pass a criminal background check
  • First Aid and CPR Certification (available at Odyssey House)
  • Must comply with annual TB tests and Flu immunization (and other immunizations as needed)
  • Must meet employment eligibility
  • Must be able to work variable shifts as needed


All employees of Odyssey House are required to adhere to: Odyssey House mission, philosophy, and scope of service; Division of Human Services Code of Conduct and all other relevant service contract requirement standards; ensuring a safe environment for all clients and staff; providing exemplary customer service to both internal and external customers; fostering a positive work environment; ensuring high-quality client care within the scope of the assigned position.   


Each employee is expected to clearly understand roles and responsibilities regarding the following: Specific job positions, time management, personnel file requirements, client record system, incident reporting, mandatory training requirements, maintaining proper client boundaries, and individual rights of clients and staff.   


Physical Demands of the Job: Ability to lift up to 15 lbs., drive (or adequate alternate transportation), sit for prolonged periods, and perform light to moderate physical activity at times. Able to passively restrain residents without likely injury to self due to existing medical condition.  


EEOC Statement: Odyssey House is an equal-opportunity employer. All aspects of employment, including the decision to hire, promote, discipline, or discharge, will be based on merit, competence, performance, and business needs. We do not discriminate based on race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law.  

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