ZipRecruiter

Log In

2

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 ...

next page

Showing results 1-20

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/Clinical Review RN -PRN

Utilization/Clinical Review RN -PRN

Children's Healthcare of Atlanta

Atlanta, GA • On-site

Part-time

Re-posted 28 days ago

Children's Healthcare Of Atlanta rating

7.5

Company rating: 7.5 out of 10

Based on 127 frontline employees who took The Breakroom Quiz

231st of 885 rated healthcare providers

Job description

Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs).
Work Shift
Variable
Work Day(s)
Variable
Shift Start Time
6:00 AM
Shift End Time
5:00 PM
Worker Sub-Type
PRN
Children's is one of the nation's leading children's hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We're committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. Find your next career opportunity and make a difference doing what you love at Children's.
Job Description
Participates as a member of a multidisciplinary team in completing pre-screening assessments of prospective patients. Ensures completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical Review Specialist as indicated. Maintains necessary documentation and communication with internal and external customers.
This role is PRN and requires (6) 8-hour days per month with 1 day being on the weekend. We'll be open to offering more if possible. Some Holidays are required as well.
Training/Orientation will be 3 days/week (8-hour days) for 8-10 weeks. Onsite Orientation is needed 3-4 days for first week.
This role will be remote BUT regular meetings/trainings require being onsite at the Support Center in Atlanta GA.
Experience
  • 3 years of experience in a healthcare setting; pediatrics preferred

Preferred Qualifications
  • Bachelor of Science in Nursing
  • Previous experience with MCG and/or InterQual systems
  • 2 years of experience in hospital or insurance related utilization review highly preferred

Education
  • Graduation from an accredited school of nursing

Certification Summary
  • Licensure as a Registered Nurse in the single State of Georgia or Multi-State through the Enhanced Nurse Licensure Compact

Knowledge, Skills, and Abilities
  • Working knowledge of financial aspects of third-party payors and reimbursement
  • Effective decision-making/problem-solving skills
  • Demonstration of creativity in problem-solving
  • Must possess above-average computer skills
  • Must be able to successfully pass the Basic Windows Skill Assessment at 80% or higher rating within 30 days of employment

Job Responsibilities
  • Provides clinical information to insurance companies as needed for completion of pre-certification process as noted in Children's Healthcare of Atlanta utilization management plan.
  • Evaluates all patients, including critical care, for appropriateness of admission type and setting, utilizing a combination of clinical information, screening criteria, and third-party information within 24 hours or next business day.
  • Initiates and facilitates physician communications relative to utilization review process when indicated without prompting and follows up to ensure completion, including peer-to-peer reviews, securing admission orders, and reporting quality issues.
  • Reviews concurrently all inpatients, including critical care, every three days or sooner if payor requests, including information regarding patient's medical condition, intensity of services being utilized, treatment plan, and established review criteria.
  • Ensures all pertinent information is documented into various systems for utilization review process.
  • Gathers and reviews relevant medical information and documents utilization review process outcome based on system accepted utilization criteria on the accepted current review forms and in computer systems.
  • Supports organizational efforts to ensure accurate capture of admission status and level of care using Epic and escalating cases for status change where necessary.
  • Refers denied cases to appropriate personnel and provides assistance and/or clinical support to aid in appeal process.
  • Serves as resource to Case Management for facilitation of patients moving to appropriate level of care and notifying when patients no longer meet medical necessity to aid in discharge planning.
  • Meets productivity (10-12 reviews/day) and quality assurance (95%) standards and demonstrates utilization review proficiency with the successful completion and passing of McKesson Interrater Reliability testing.
  • Attends all required onsite, telephonic, and mandatory department meetings.
  • Participates in department activities to help promote utilization review process, aids in denial prevention, and serves as resource to peers and team members.

Children's Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law.
Primary Location Address
1575 Northeast Expy NE
Job Family
Nursing-Non Bedside

What Children's Healthcare Of Atlanta employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply