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Remote Hca Utilization Review Jobs in Michigan (NOW HIRING)

Pharmacy Careers

Appeals Pharmacist (Remote)

Ypsilanti, MI · On-site +1

$51.75 - $63/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Detroit, MI · On-site +1

$52.50 - $63.75/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Curbee

Dealer Success Manager

Detroit, MI · On-site +1

$90K - $115K/yr

S. (Mobile and Remote Service). With Curbee., it's simple: dealerships send the right van to the ... Perform MBRs and QBRs, track key metrics like appointments, utilization, and review results on a ...

OpTech

Senior Health Care Data Analyst (SAS / SQL)

Detroit, MI · On-site +1

$78K - $99K/yr

... remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our ... This position operates within broad objectives to ensure optimum utilization of manpower and budget

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Remote Hca Utilization Review information

What is the difference between Remote Hca Utilization Review vs Remote Hca Case Manager?

AspectRemote Hca Utilization ReviewRemote Hca Case Manager
CredentialsTypically requires healthcare-related certifications, such as RN or licensed healthcare professionalOften requires RN, social work, or case management certifications
Work EnvironmentPrimarily reviewing medical necessity and insurance coverage remotelyManaging patient cases, coordinating care, and discharge planning remotely
Employer & Industry UsageUsed by health insurance companies, healthcare providers, and utilization review organizationsEmployed by hospitals, insurance companies, and healthcare organizations

Remote Hca Utilization Review focuses on assessing medical necessity and insurance coverage, while Remote Hca Case Managers handle patient care coordination and discharge planning. Both roles require healthcare credentials and are integral to healthcare management, but they differ in daily responsibilities and focus areas.

What are popular job titles related to Remote Hca Utilization Review jobs in Michigan? For Remote Hca Utilization Review jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Remote Hca Utilization Review jobs in Michigan look for? The top searched job categories for Remote Hca Utilization Review jobs in Michigan are:
What cities in Michigan are hiring for Remote Hca Utilization Review jobs? Cities in Michigan with the most Remote Hca Utilization Review job openings:
Remote Hca Utilization Review jobs near you
Utilization Review Assistant- Remote

Utilization Review Assistant- Remote

Hurley Medical Center

Flint, MI • On-site, Remote

Full-time

Posted 16 days ago

Hurley Medical Center rating

6.9

Company rating: 6.9 out of 10

Based on 27 frontline employees who took The Breakroom Quiz

531st of 999 rated hospitals

Job description

Job Description
This position will assist in the coordination of all activities related to insurance authorizations process for the Patient Access Utilization Review (UR) department. Activities may consist of collaborating with various medical staff and Medical Center personnel, participating in non-clinical appeals process, obtaining status updates on all outstanding appeals, monitoring and tracking of all financial activities related to the UR team. Participates in quality management and continuous quality improvement activities. Perform all job duties and responsibilities in a courteous and customer-focused manner according to the Hurley Family Standards of Behavior. Works under the direction of the Director of Patient Access or designee who reviews work for effectiveness and compliance with established standards, policies, and procedures.
Responsibilities
  1. Perform necessary authorization-related tasks in an accurate and timely manner. This includes utilization of the Epic EMR system efficiently and effectively and providing sufficient and clear documentation of all actions taken.
  2. Assist in the initial authorization approval process by communicating with various payers and other internal Medical Center personnel and submitting pertinent documentation to the payers for approval consideration.
  3. Assist in submitting concurrent and retrospective reviews to appropriate payers. This may require following up with physicians and other health care providers to review admissions and continued stays not meeting criteria.
  4. Stay abreast of health care benefit inclusions and exclusions for all financial classes, benefit changes, review requirements, and other pertinent regulations influencing the Medical Center.
  5. Assist with appeals of denied days by third-party reviewers throughout each stage of available reconsideration/appeal mechanisms.
  6. Review charts for instances of over/under utilization of ancillary services to ensure optimum quality of care and maximum reimbursement.
  7. Collaborate with the Patient Access/Registration, Medical Records, Billing teams, and other hospital areas to ensure post discharge completion of all information necessary to generate timely billing.
  8. Assist in drafting letters to third-party review entities and medical staff members and working with the Utilization Review Coordinators for approval and finalization of such letters.
  9. Assist in identification, development, and implementation of new procedures designed to increase operating efficiency.
  10. Review level of care for patients (with UR Coordinators and medical staff approval) regarding inpatient, observation, and outpatient care and relate this information to the Revenue Cycle teams for billing purposes.
  11. Maintain all primary assignments (based on financial goals assigned to the UR department). This consists of working on Discharge Not Billed (DNB), Claim Edits, and Stop Bill work queues or reports to accomplish timely accounts resolution.
  12. Perform other related duties as required/assigned. Utilizes new improvements and/or technologies that relate to job assignment.

Qualifications
  • Associate's degree in healthcare or related field required (Bachelor's degree preferred).
  • Two (2) years of healthcare experience in authorizations, coding, patient registration, billing, or utilization review.
  • Knowledge of hospital patient care admission processes and third party payer utilization requirements.
  • Strong background and knowledge of payer authorizations and referrals.
  • Ability to communicate effectively in oral and written modes.
  • Ability to interact courteously and effectively with all levels of the Medical Center staff, patients, medical staff, external agency representatives, and the public.

NOTE: If the incumbent is skillfully prepared and actively pursuing a degree, they will be required to obtain minimally an Associate's degree within one (1) year of accepting the position.

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