In this position you will be reviewing patient charts to determine if pre-elective surgical cases ... Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES ...
In this position you will be reviewing patient charts to determine if pre-elective surgical cases ... Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES ...
In this position you will be reviewing patient charts to determine if pre-elective surgical cases ... Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES ...
In this position you will be reviewing patient charts to determine if pre-elective surgical cases ... Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES ...
Director of Utilization Management
Troy, MI · On-site +1
$160K - $160K/yr
Prepare and maintain Utilization Review Plan policies and procedures * Obtain or maintain ... Career development opportunities Remote Opportunities We are actively seeking new colleagues in:
Director of Utilization Management
Troy, MI · On-site +1
$160K - $160K/yr
Prepare and maintain Utilization Review Plan policies and procedures * Obtain or maintain ... Career development opportunities Remote Opportunities We are actively seeking new colleagues in:
Previous experience in quality assurance, utilization review, or clinical leadership * Experience ... Remote work opportunity * Health, dental, and vision insurance * Paid Time Off * Paid holidays ...
Quick apply
Previous experience in quality assurance, utilization review, or clinical leadership * Experience ... Remote work opportunity * Health, dental, and vision insurance * Paid Time Off * Paid holidays ...
Manager Cash Posting/Applications - (Credit Resolutions) - PFS (Remote)
Farmington Hills, MI · On-site +1
$37.70 - $55.60/hr
POSITION PURPOSE Work Remote Position Manages and oversees a team responsible for daily cash ... utilization. Reviews cash posting trends, makes recommendations for resolution of issues and ...
New
Manager Cash Posting/Applications - (Credit Resolutions) - PFS (Remote)
Farmington Hills, MI · On-site +1
$37.70 - $55.60/hr
POSITION PURPOSE Work Remote Position Manages and oversees a team responsible for daily cash ... utilization. Reviews cash posting trends, makes recommendations for resolution of issues and ...
New
RN Care Manager - PRN
Almont, MI · Remote
$41.20 - $62.17/hr
Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
RN Care Manager - PRN
Almont, MI · Remote
$41.20 - $62.17/hr
Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... Essential Job Duties Performs audits in utilization management, care management, member assessment ...
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... Essential Job Duties Performs audits in utilization management, care management, member assessment ...
Auditor, Healthcare Services (Remote in MI)
Detroit, MI · On-site +1
$26.41 - $51.49/hr
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... Essential Job Duties • Performs audits in utilization management, care management, member ...
Auditor, Healthcare Services (Remote in MI)
Detroit, MI · On-site +1
$26.41 - $51.49/hr
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... Essential Job Duties • Performs audits in utilization management, care management, member ...
Auditor, Healthcare Services (Remote in MI)
Detroit, MI · Remote
$26.41 - $51.49/hr
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... Essential Job Duties • Performs audits in utilization management, care management, member ...
Auditor, Healthcare Services (Remote in MI)
Detroit, MI · Remote
$26.41 - $51.49/hr
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... Essential Job Duties • Performs audits in utilization management, care management, member ...
Lead operational governance activities across assigned Clubs, including creative review oversight ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements
Lead operational governance activities across assigned Clubs, including creative review oversight ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements
Lead operational governance activities across assigned Clubs, including creative review oversight ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements
Lead operational governance activities across assigned Clubs, including creative review oversight ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements
Health & Social Services RN - Remote in Michigan
Southfield, MI · On-site +1
$29 - $52/hr
Experience in utilization review, concurrent review or risk management * Background in managing populations with complex medical or behavioral needs * Acute care experience *All Telecommuters will be ...
Health & Social Services RN - Remote in Michigan
Southfield, MI · On-site +1
$29 - $52/hr
Experience in utilization review, concurrent review or risk management * Background in managing populations with complex medical or behavioral needs * Acute care experience *All Telecommuters will be ...
Health & Social Services RN - Remote in Michigan
Southfield, MI · Remote
$29 - $52/hr
Experience in utilization review, concurrent review or risk management * Background in managing populations with complex medical or behavioral needs * Acute care experience *All Telecommuters will be ...
Health & Social Services RN - Remote in Michigan
Southfield, MI · Remote
$29 - $52/hr
Experience in utilization review, concurrent review or risk management * Background in managing populations with complex medical or behavioral needs * Acute care experience *All Telecommuters will be ...
Remote Community Based Clinical Coordinator - Care Manager- Luce County, MI
Newberry, MI · On-site +1
$29.72/hr
... utilization, past and present treatment plan and services, prognosis, short and long-term goals ... reviewing statistical data Other Requirements: Valid Driver's License with proof of insurance ...
Remote Community Based Clinical Coordinator - Care Manager- Luce County, MI
Newberry, MI · On-site +1
$29.72/hr
... utilization, past and present treatment plan and services, prognosis, short and long-term goals ... reviewing statistical data Other Requirements: Valid Driver's License with proof of insurance ...
Remote Community Based Clinical Coordinator - Care Manager- Chippewa County, MI
Sault Sainte Marie, MI · On-site +1
$29.72/hr
... utilization, past and present treatment plan and services, prognosis, short and long-term goals ... reviewing statistical data Other Requirements: Valid Driver's License with proof of insurance ...
Remote Community Based Clinical Coordinator - Care Manager- Chippewa County, MI
Sault Sainte Marie, MI · On-site +1
$29.72/hr
... utilization, past and present treatment plan and services, prognosis, short and long-term goals ... reviewing statistical data Other Requirements: Valid Driver's License with proof of insurance ...
Remote Community Based Clinical Coordinator - Care Manager - Mackinac County, MI
Saint Ignace, MI · On-site +1
$29.72/hr
... utilization, past and present treatment plan and services, prognosis, short and long-term goals ... reviewing statistical data Other Requirements: Valid Driver's License with proof of insurance ...
Remote Community Based Clinical Coordinator - Care Manager - Mackinac County, MI
Saint Ignace, MI · On-site +1
$29.72/hr
... utilization, past and present treatment plan and services, prognosis, short and long-term goals ... reviewing statistical data Other Requirements: Valid Driver's License with proof of insurance ...
Director, Trade Client Relations
Three Rivers, MI · Remote
$155K - $175K/yr
Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed
Director, Trade Client Relations
Three Rivers, MI · Remote
$155K - $175K/yr
Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed
Medical Coding Specialist
Troy, MI · On-site +1
$65K - $65K/yr
The Medical Coding Specialist provides coding expertise to support Utilization Management ... Quality Review • Perform thorough self review of work prior to submission to ensure accuracy ...
Medical Coding Specialist
Troy, MI · On-site +1
$65K - $65K/yr
The Medical Coding Specialist provides coding expertise to support Utilization Management ... Quality Review • Perform thorough self review of work prior to submission to ensure accuracy ...
Supervisor, Clinical Documentation Integrity (CDI) - (Remote)
Livonia, MI · On-site +1
$32.50 - $43.75/hr
... sets and optimal utilization of the 3M CDI software. Responsible for scheduling and work ... May perform CDI reviews to support program during high volume, short staffing periods. Maintains a ...
Supervisor, Clinical Documentation Integrity (CDI) - (Remote)
Livonia, MI · On-site +1
$32.50 - $43.75/hr
... sets and optimal utilization of the 3M CDI software. Responsible for scheduling and work ... May perform CDI reviews to support program during high volume, short staffing periods. Maintains a ...
Software Engineering Manager
Detroit, MI · On-site +1
Hybrid remote model allows the flexibility to work remotely as much as desired. * Paid time off for ... Voluntary benefits package including telemedicine, PetCare, chiropractic, lab testing, and ...
Quick apply
Software Engineering Manager
Detroit, MI · On-site +1
Hybrid remote model allows the flexibility to work remotely as much as desired. * Paid time off for ... Voluntary benefits package including telemedicine, PetCare, chiropractic, lab testing, and ...
Remote Chiropractic Utilization Review information
What are the key skills and qualifications needed to thrive as a remote chiropractic utilization review specialist?
To thrive as a Remote Chiropractic Utilization Review specialist, you need a Doctor of Chiropractic degree, a valid state license, and comprehensive knowledge of chiropractic procedures and medical necessity guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certification such as Certified Professional Utilization Review (CPUR) is often required. Strong analytical skills, attention to detail, and effective communication are crucial for evaluating clinical documentation and collaborating with providers. These skills ensure accurate, evidence-based reviews that support appropriate patient care and compliance with insurance standards.
What is the difference between Remote Chiropractic Utilization Review vs Remote Chiropractic Billing Specialist?
| Aspect | Remote Chiropractic Utilization Review | Remote Chiropractic Billing Specialist |
|---|---|---|
| Primary Role | Assessing medical necessity and appropriateness of chiropractic treatments | Managing billing, coding, and insurance claims for chiropractic services |
| Required Credentials | Chiropractic license, possibly certifications in utilization review | Medical billing certifications, knowledge of coding and insurance policies |
| Work Environment | Remote, healthcare or insurance companies | Remote, healthcare providers or billing companies |
| Industry Usage | Used by insurance companies and healthcare organizations to approve treatments | Used by billing companies and healthcare providers for claims processing |
Remote Chiropractic Utilization Review focuses on evaluating the medical necessity of chiropractic treatments, while Remote Chiropractic Billing Specialist handles billing, coding, and insurance claims. Both roles are remote and require healthcare knowledge, but they serve different functions within the chiropractic industry.
What is a remote chiropractic utilization review?
A Remote Chiropractic Utilization Review is a process where licensed chiropractors or healthcare professionals assess the necessity, efficiency, and appropriateness of chiropractic care provided to patients, but do so remotely—often from home or a centralized office. This review typically involves examining patient records, treatment plans, and billing information to ensure that care meets established clinical guidelines and insurance requirements. The goal is to improve patient outcomes, prevent unnecessary treatments, and ensure that services billed to insurance are medically necessary. Remote reviews use secure online systems and may require coordination with treating chiropractors, insurance companies, and other healthcare providers.
What are some common challenges faced in a remote chiropractic utilization review role, and how can they be managed?
One of the main challenges in a remote Chiropractic Utilization Review role is effectively evaluating clinical documentation to ensure treatment appropriateness without direct patient interaction. Communication with providers can sometimes be limited or delayed, requiring strong written and verbal skills to clarify cases efficiently. Managing time and workflow independently is crucial, as the workload may fluctuate throughout the week. Staying updated with payer guidelines and evidence-based practices is also essential for accurate reviews. Building strong virtual collaboration with team members and providers can help overcome these challenges and maintain high-quality standards.
What are the most commonly searched types of Chiropractic Utilization Review jobs in Michigan? The most popular types of Chiropractic Utilization Review jobs in Michigan are:
What are popular job titles related to Remote Chiropractic Utilization Review jobs in Michigan? For Remote Chiropractic Utilization Review jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Remote Chiropractic Utilization Review jobs in Michigan look for? The top searched job categories for Remote Chiropractic Utilization Review jobs in Michigan are:
What cities in Michigan are hiring for Remote Chiropractic Utilization Review jobs? Cities in Michigan with the most Remote Chiropractic Utilization Review job openings:
Full-time
Re-posted 13 days ago
Job description
In this position you will be reviewing patient charts to determine if pre-elective surgical cases should be boarded as inpatient instead of outpatient. You will also review the CPTs that were boarded for meeting inpatient on the CMS inpatient list and the InterQual inpatient list based on payer criteria used.
Hours are Monday - Friday from 830am until 5pm with no weekends
EDUCATION AND EXPERIENCE:
- RHIT, RHIA, or related coding certification required.
- Minimum 3-5 years of clinical experience preferred.
- Previous utilization management or case management experience preferred.
CERTIFICATIONS/LICENSURES REQUIRED:
- RHIT, RHIA, or related coding certification required.
Additional Information
- Organization: Corporate Services
- Department: Central Utilization Mgt
- Shift: Day Job
- Union Code: Not Applicable