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Remote Insurance Utilization Review Jobs in Utah

Veteran Jobs - 2023 Mar 01 - Veterans Resources

$52K - $68K/yr

May provide utilization management review and authorization of behavioral health (BH) and substance ... Remote

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Remote Insurance Utilization Review information

What is the difference between Remote Insurance Utilization Review vs Remote Claims Reviewer?

AspectRemote Insurance Utilization ReviewRemote Claims Reviewer
CredentialsTypically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professionalUsually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H
Work EnvironmentRemote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of servicesRemote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance
Industry UsageCommonly used in healthcare insurance to evaluate medical necessityUsed across insurance sectors to process and validate claims

Remote Insurance Utilization Review focuses on assessing the medical necessity of services, often requiring healthcare credentials. Remote Claims Reviewers handle claims processing and validation, emphasizing insurance knowledge. Both roles are remote and industry-specific but differ in their primary responsibilities and required qualifications.

How does a remote insurance utilization review professional collaborate with healthcare providers and insurance companies?

Remote insurance utilization review professionals regularly interact with healthcare providers to gather patient information, clarify treatment plans, and ensure that clinical documentation supports insurance requirements. They also communicate with insurance companies to advocate for patient care, provide necessary justifications, and resolve coverage issues. While the work is done remotely, collaboration typically occurs via secure email, phone calls, and virtual meetings, requiring strong communication and organizational skills to ensure timely and accurate exchange of information.

What are remote insurance utilization review jobs?

Remote insurance utilization review jobs involve evaluating medical records and treatment plans to determine whether healthcare services are medically necessary and covered by a patient’s insurance plan. Professionals in these roles, often nurses or other healthcare specialists, work from home and communicate with healthcare providers, insurance companies, and patients. Their main goal is to ensure that patients receive appropriate care while also helping insurance companies manage costs and comply with regulations.

What are the key skills and qualifications needed to thrive as a Remote Insurance Utilization Review Specialist, and why are they important?

To thrive as a Remote Insurance Utilization Review Specialist, you need a strong understanding of medical terminology, clinical guidelines, and insurance policies—usually supported by a nursing or health-related degree and relevant licensure. Familiarity with electronic medical record (EMR) systems, insurance claims platforms, and utilization review software is essential. Strong analytical skills, attention to detail, and effective written communication are crucial soft skills for this role. These competencies ensure accurate case evaluations, compliance with regulations, and clear communication between healthcare providers and insurers.
What are popular job titles related to Remote Insurance Utilization Review jobs in Utah? For Remote Insurance Utilization Review jobs in Utah, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Utah look for? The top searched job categories for Remote Insurance Utilization Review jobs in Utah are:
What cities in Utah are hiring for Remote Insurance Utilization Review jobs? Cities in Utah with the most Remote Insurance Utilization Review job openings:
Remote Insurance Utilization Review jobs near you
Clinical Care Navigator - Licensed Clinician - Remote US - Sat-Sun

Clinical Care Navigator - Licensed Clinician - Remote US - Sat-Sun

Veteran Jobs - 2023 Mar 01 - Veterans Resources

Remote

$52K - $68K/yr

Other

Posted 10 days ago

Job description

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps. 
***This role requires current licensure. Must be a master's level licensed clinician.*****
20 hours part-time, Saturday 7am-6pm CST and Sunday 7am-6pm CST.
Under supervision of clinical leadership, the navigator is a phone queue based role responsible for answering calls from Magellan members, individual providers, facilities, and customer representatives. May provide utilization management review and authorization of behavioral health (BH) and substance use disorder (SUD) services ranging from outpatient counseling to inpatient levels of care. May assist with connection to Employee Assistance Program (EAP) services including counseling, coaching, Critical Incident Response and Workplace Support Services (WPS). Responsible for triaging calls, determining level of risk, managing crisis calls, and assessing members for all types of risk following Magellan's established crisis call protocols. Navigators will be assigned additional responsibilities based on level of experience.
Manage EAP service requests within scope of clinical role including in the moment telephonic consultation, connection to EAP counseling, education and connection to other EAP benefits. Conduct risk assessment and assessment of social determinants of health needs on all calls. Provide WPS Supervisor Consultations, manage requests for Critical Incident Response, submit requests for urgent/routine member appointment searches.  (30%)
    Provides utlization management review and authorization of behavioral health and substance use disorder services ranging from outpatient to inpatient levels of care utilizing applicable Medical Necessity Critera (MNC) guidelines. Assists members and facilities in coordinating and accessing benefit eligible treatment. (30%)
    Provide crisis call management. Follow crisis call protocols and connect to emergency services, mobile crisis response, and/or other crisis resources as appropriate. Outreach to members assessed as high risk. (20%)
    Assist members with accessing benefit eligible EAP, BH or SUD treatment via bed searches and routine/urgent appointment searches. Manage requests and complete outreach for Critical Incident Response event staffing. (10%)
    When off queue, other responsibilities include completing required corporate and clinical trainings, participation in individual supervision and team meetings, gathering and submitting customer feedback and supporting Magellan holiday phone queue coverage. (10%)
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