1

Non Clinical Utilization Review Jobs in Puerto Rico

$89K - $116K/yr

... clinical volume, reviewing work of employees to assure accuracy and validity of submissions ... Non-citizens may only be appointed when it is not possible to recruit qualified citizens in ...

PR

$38/hr

Strong experience in reviewing and approving deviations, critical utilities, and environmental ... Approving work orders, EMS/BMS alarms, non-conformance investigations, and CAPA records * Approving ...

Experience in batch record review, audit trail reviews and GDP with focus on data integrity (ALCOA ... Available to work all shifts- non standard shifts- including weekends, 12hrs shifts, rotate, OT and ...

PR · On-site

$16.75 - $21.75/hr

... clinical, clinical, and commercial start. We behave more like a cGMP incubator space with all ... Establish routine and non-routine cleaning schedules, procedures, and workflows for classified ...

... systems such as non-conformances, process validation, procedures, training, and new product ... Kelly Science & Clinical is your connection to premier scientific and clinical companies looking to ...

Physician

Arecibo, PR · On-site +1

$124K - $400K/yr

Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified ... Clinical Laboratory Medicine). * English Language Proficiency- Must be proficient in spoken and ...

Senior Engineer

Juncos, PR · On-site

$101K - $139K/yr

Provide support, as needed, to clinical and commercial fill/finish manufacturing operations through ... non-conformance investigations and process changes/improvements. * Author and review guideline ...

$124K - $400K/yr

... after review of the EDRP application. Former EDRP participants ineligible to apply. The ... Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified ...

Showing results 41-60

Non Clinical Utilization Review information

What is the difference between Non Clinical Utilization Review vs Clinical Utilization Review?

AspectNon Clinical Utilization ReviewClinical Utilization Review
CredentialsTypically requires healthcare administration, insurance, or case management certificationsRequires clinical licenses such as RN, MD, or other healthcare provider credentials
Work EnvironmentOffice-based, insurance companies, or healthcare organizationsHospitals, clinics, or healthcare facilities
Employer & Industry UsageInsurance companies, third-party administrators, healthcare organizationsHospitals, clinics, healthcare providers
Search & Comparison IntentUnderstanding administrative and insurance-focused review rolesUnderstanding clinical decision-making and patient care review roles

Non Clinical Utilization Review involves assessing healthcare services from an administrative perspective, focusing on insurance policies and coverage. Clinical Utilization Review involves healthcare professionals evaluating patient care and clinical necessity. Both roles are essential in healthcare but differ mainly in credentials, work environment, and focus area.

What are popular job titles related to Non Clinical Utilization Review jobs in Puerto Rico?

For Non Clinical Utilization Review jobs in Puerto Rico, the most frequently searched job titles are:

What cities in Puerto Rico are hiring for Non Clinical Utilization Review jobs?

Cities in Puerto Rico with the most Non Clinical Utilization Review job openings:

$89K - $116K/yr

Full-time

PTO

Posted 8 days ago


Veterans Health Administration rating

8.1

Company rating: 8.1 out of 10

Based on 1,004 frontline employees who took The Breakroom Quiz

69th of 888 rated healthcare providers


Job description

Summary
This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific eligibility requirements per VHA policy and submit your EDRP application within four months of appointment. Program Approval, award amount (up to $200,000) & eligibility period (one to five years) are determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply
Learn more about this agency
Duties
Help
The Supervisory Recreation Therapist is responsible for the supervision of administrative management, and direction of the Recreation Therapy Department with services offered to hospitalized and ambulatory patients, Community Living Center, and Behavioral Health Service at the VA Caribbean Healthcare System (VACHS). RT/CAT services are provided at the inpatient rehabilitation unit, the Interdisciplinary Pain Rehabilitation Program, behavioral health programs including but not limited to: Acute Behavioral Health Inpatient Care Unit (ABHICU), Psychosocial Rehabilitation and Recovery Center (PRRC), Mental Health Residential Rehabilitation Treatment Program-Domiciliary (MHRRTP), New Beginnings and Intensive Out Patient (IOP), PTSD Clinic, and Behavioral Health Interdisciplinary Program (BHIP). The position is located under the Physical Medicine and Rehabilitation Service. Duties include but are not limited to:
  • Supervisory responsibilities for all Recreation and Creative Arts Therapists, Recreation Therapy Assistants, trainees, and volunteers in the delivery and/or support of treatment and education of patients and families within the scope of this position.
  • Assigns and monitors clinical performance of RT/CAT staff including technical oversight to assure prompt and smooth delivery of recreation therapy services to patients.
  • Consults with physicians, members of the rehabilitation team and other health professionals through case presentations, attendance at ward rounds, re-evaluation clinics, treatment and discharge meetings and educational lectures or conferences. Coordinates with other sections and other services in the area of RT/CAT treatment, treatment scheduling, and delivery of care.
  • Observes the utilization of recreation therapy treatment modalities to ensure the most beneficial program for the patient considering available resources.
  • Demonstrates independence in performing supervisory responsibilities that include, but are not limited to, assigning work to employees, monitoring workload and clinical volume, reviewing work of employees to assure accuracy and validity of submissions, imposing disciplinary measures, and monitoring clinical competencies.
  • Guides and manages clinics in respect to training, work assignments, performance, conduct, and patient well-being.
  • Identifies and coordinates continuing education and trainings needs based on performance evaluations, performance improvement activities, competency assessment, state of the art technologies etc.
  • Collaborates with academic institutions for the clinical training of recreation and creative arts therapy students.

Work Schedule: Monday - Friday, 7:30 am - 4:00 pm or 8:00 am - 4:30 pm
Telework: AD HOC
Virtual: This is not a virtual position.
Functional Statement #: 62587F
Relocation/Recruitment Incentives: Not Authorized
EDRP Authorized: Former EDRP participants ineligible to apply for incentive.Contact VHAEDRPProgramSupport@va.gov, the EDRP Coordinator for questions/assistance. Learn more
Permanent Change of Station (PCS): Not Authorized
Requirements
Help
Conditions of employment
  • You must be a U.S. Citizen to apply for this job.
  • All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
  • Selective Service Registration is required for males born after 12/31/1959.
  • Must be proficient in written and spoken English.
  • Subject to background/security investigation.
  • Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued dentification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment.
  • Must pass pre-employment physical examination.
  • Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
  • Complete all application requirements detailed in the "Required Documents" section of this announcement.
  • Spanish proficiency

As a condition of employment for accepting this position, you will be required to serve a 1 or 2-year trial period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider:
  • your performance and conduct;
  • the needs and interests of the agency;
  • whether your continued employment would advance organizational goals of the agency or the Government; and
  • whether your continued employment would advance the efficiency of the Federal service.

Upon completion of your trial period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.
Qualifications
Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met.
Basic Requirements:
  • United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
  • English Language Proficiency: Supervisory Recreation Therapist candidates must be proficient in spoken and written English in accordance with 38 U.S.C. § 7403(f).
  • Education-
    • A bachelor's degree or higher, from an accredited college or university, with a major in therapeutic recreation or recreation/leisure, with an option and/or emphasis in therapeutic recreation. The degree must be approved by the National Council for Therapeutic Recreation Certification (NCTRC); ~OR~
    • A bachelor's degree or higher in any field from an accredited college or university and must be a certified therapeutic recreation specialist (CTRS). The degree must be approved by the NCTRC. If hired under this education, the certification cannot be waived.
  • Certification-Documentation Submitted. Recreation Therapist. Applicants must be certified in recreation therapy as a CTRS by the NCTRC. If hired under paragraph 4b(1)(b), certification cannot be waived.

Grandfathering Provision: May qualify based on being covered by the Grandfathering Provision as described in the VA Qualification Standard for this occupation (only applicable to current VHA employees who are in this occupation and meet the criteria).
Grade Determinations:
GS-12:
Experience. One year equivalent to the next lower grade directly related to the position being filled. Experience include: developing positive patterns of behavior; relaxation and stress reduction; lifestyle alteration; social skills training; developing or improving (enhancing) self-esteem; developing and maintaining positive relationships; motor learning and training strategies; anger and pain management; identify risks; recovery support; lifestyle adjustment; conflict/problem resolution; adjustment to disability; and including coping with grief and loss. Resourcefulness is exercised in providing individualized, unique, effective methods and procedures when implementing therapeutic interventions including, but not limited to: assistive technology; cognitive behavioral skills; aquatic therapy; fitness and wellness; community accessibility/reintegration/transition; and adapted sports and leisure development. Patient needs are evaluated for additional, alternative, or termination of services. Intervention plans are monitored for effectiveness, making modifications, as needed. Recreation therapists determine the effectiveness of protocols, modalities, and programs for targeted groups through quantitative analysis and identify potential risks and needs for adaptive interventions to facilitate improved biopsychosocial well-being. They participate in co-treatment opportunities, including but not limited to: neurological rehabilitation, mental health recovery programs, and palliative care related to the symptoms of a terminal illness. Discharge analysis and planning is conducted for community needs.
Demonstrated Knowledge, Skills, and Abilities. In addition to the experience above, the candidate must demonstrate all of the following KSAs:
  • Ability to provide treatment in complex cases and work with great independence.
  • Ability to balance multiple responsibilities, set priorities, delegate tasks, meet multiple deadlines, analyze organizational problems, and develop and implement effective solutions.
  • Ability to analyze organizational and operational problems to develop and implement solutions that result in efficient operations and use data effectively to manage workload, quality, performance, and productivity within the service.
  • Skill in interpersonal relationships in dealing with employees, team leaders, and managers.
  • Ability to use evidence-based practices, clinical practice guidelines in a professional area, and to guide the staff in applying these tools.
  • Knowledge of organizational theories and strategies to positively impact the overall goals and objectives within the service.
  • Knowledge related to administrative functions such as fiscal, material supply, equipment management, and clinical and program management

Note: Please ensure how you meet the experience is clearly described in your resume; we may not make assumptions regarding your experience.
Selective Placement Factor (SPF) for locations in Puerto Rico- This position includes a skill, knowledge, ability or other worker characteristic basic to -and essential for- satisfactory performance of the job. Selective Placement Factors are a prerequisite to appointment and represent minimum requirements for a position. Applicants who do not meet it are ineligible for further consideration. Evidence of the Selective Placement Factor must be reflected in your resume. The SPF for this position is: In addition to the English Language Proficiency, you must also be proficient in basic written and spoken Spanish in order to perform the duties of this position.
Preferred Experience:
  • Skills in interpersonal relationships in dealing with employees, customers and leadership.
  • Knowledge in supervisory and administrative duties such as time management, conflict resolution, program development, workload distribution, and employee engagement and professional development.

Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.
The full performance level of this vacancy is GS-12. The actual grade at which an applicant may be selected for this vacancy is GS-12.
Physical Requirements: Recreation Therapist work may demand prolonged standing, sitting, carrying and lifting of equipment as required for the interventions. It will also require participation in trainings, interventions and special activities in both in-house and off-station settings.
Education
Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.
Additional information
Receiving Service Credit for Earning Annual (Vacation) Leave: Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience. This credited service can be used in determining the rate at which they earn annual leave. Such credit must be requested and approved prior to the appointment date and is not guaranteed.
During the application process you may have an option to opt-in to make your resume available to hiring managers in the agency who have similar positions. Opting in does not impact your application for this announcement, nor does it guarantee further consideration for additional positions.
This job opportunity announcement may be used to fill additional vacancies.
This position is in the Excepted Service and does not confer competitive status.
VA encourages persons with disabilities to apply. The health-related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority.
If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement.
Under the Fair Chance to Compete Act, the Department of Veterans Affairs

What Veterans Health Administration employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom


Veterans Health Administration logo

About Veterans Health Administration

Sourced by ZipRecruiter

The Veterans Health Administration (VHA) is the largest integrated health care system in the United States, serving millions of Veterans each year. Located in Phoenix, AZ, and many other parts of the US, the VHA operates under the Department of Veteran Affairs, as suggested by their official website va.gov. The VHA is dedicated to providing the highest level of comprehensive care to its veterans. The organization offers a broad spectrum of medical, surgical, and rehabilitative care, including mental health services, research, and pharmacy benefits.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Phoenix, AZ, US