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Part Time Weekend Utilization Review Jobs in Georgia

Planet Fitness

Part Time Weekend

Cedartown, GA · On-site

We will review applications and if we feel as though your application meets our qualifications we will reach out to you to schedule an interview. Please fill out application and submit resume. If one ...

Childrens Healthcare of Atlanta

... Mon-Fri 8A-5P), Parttime Days, PRN (6 8-hour days per month) and Weekends (Sat, Sun 7A-7P ... Experience in care coordination, case management, discharge planning, and utilization review ...

CHSGa

RN Supervisor -PT - Weekend

Metter, GA · On-site

$43.60 - $51.35/hr

... Part-time :Weekend Pay: $43.60 to $51.35 Shift differentials evenings, nights and weekends ... Reviews and responds to complaints/grievances (associate and/or patient or family) that concern ...

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All JobsUtilization Review JobsPart Time Weekend Utilization Review JobsPart Time Weekend Utilization Review Jobs in Georgia

Part Time Weekend Utilization Review information

What is the difference between Part Time Weekend Utilization Review vs Part Time Weekend Medical Coder?

AspectPart Time Weekend Utilization ReviewPart Time Weekend Medical Coder
CertificationsUtilization Review Certification, Medical License (if applicable)Certified Professional Coder (CPC), Certified Coding Specialist (CCS)
Work EnvironmentHealthcare facilities, insurance companies, remote optionsHospitals, clinics, remote coding jobs
Job FocusReviewing medical necessity, authorizing servicesTranslating medical records into billing codes
Industry UsageInsurance, healthcare managementMedical billing and coding

Part Time Weekend Utilization Review involves assessing medical necessity and authorizing healthcare services, often requiring specific utilization review certifications. In contrast, Part Time Weekend Medical Coder focuses on translating medical records into billing codes, requiring coding certifications. Both roles are common in healthcare but serve different functions within the industry.

What are the most commonly searched types of Weekend Utilization Review jobs in Georgia? The most popular types of Weekend Utilization Review jobs in Georgia are:
What cities in Georgia are hiring for Part Time Weekend Utilization Review jobs? Cities in Georgia with the most Part Time Weekend Utilization Review job openings:
Part Time Weekend Utilization Review jobs near you

Utilization Specialist

RiverWoods Behavioral Health

Riverdale, GA • On-site

Part-time

Re-posted 18 days ago

Job description

Overview

PURPOSE STATEMENT: 

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.  

Responsibilities

ESSENTIAL FUNCTIONS: 

  • Act as liaison between managed care organizations and the facility professional clinical staff. 
  • Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements. 
  • Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.  
  • Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office. 
  • Conduct quality reviews for medical necessity and services provided.   
  • Facilitate peer review calls between facility and external organizations.  
  • Initiate and complete the formal appeal process for denied admissions or continued stay.  
  • Assist the admissions department with pre-certifications of care.  
  • Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates. 

OTHER FUNCTIONS:  

  • Perform other functions and tasks as assigned. 
Qualifications

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: 

  • Required Education: High school diploma or equivalent. 
  • Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field. 
  • Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred 

LICENSES/DESIGNATIONS/CERTIFICATIONS:  

  • Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services. 
  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.   
  • First aid may be required based on state or facility requirements. 

 

ADDITIONAL REGULATORY REQUIREMENTS: 

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances  (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate. 

We are committed to providing equal  employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.

Employment Type: PART_TIME

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