Brookfield, WI · On-site +1
Utilization Review Specialist - Behavioral Health Facility We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing ...
Brookfield, WI · On-site +1
Utilization Review Specialist - Behavioral Health Facility We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing ...
Brookfield, WI · On-site +1
Utilization Review Specialist - Behavioral Health Facility We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing ...
Quick apply
Apply Early
Brookfield, WI · On-site +1
Utilization Review Specialist - Behavioral Health Facility We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing ...
Apply Early
Menasha, WI · On-site +1
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
Menasha, WI · On-site +1
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
Middleton, WI · On-site +1
$71K - $151K/yr
Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the revenue cycle program and functions within the scope ...
Middleton, WI · On-site +1
$71K - $151K/yr
Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the revenue cycle program and functions within the scope ...
Madison, WI · On-site +1
$68K - $70K/yr
Experience with medical record review or utilization review. Remote Work Requirements * Wired (ethernet cable) internet connection from your router to your computer * High speed cable or fiber ...
Madison, WI · On-site +1
$68K - $70K/yr
Experience with medical record review or utilization review. Remote Work Requirements * Wired (ethernet cable) internet connection from your router to your computer * High speed cable or fiber ...
Madison, WI · Remote
$58.75 - $70.50/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Madison, WI · Remote
$58.75 - $70.50/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Milwaukee, WI · Remote
$57.50 - $69/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Milwaukee, WI · Remote
$57.50 - $69/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Milwaukee, WI · On-site +1
$56.50 - $68.75/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Milwaukee, WI · On-site +1
$56.50 - $68.75/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Madison, WI · On-site +1
$57.75 - $70.25/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Madison, WI · On-site +1
$57.75 - $70.25/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Madison, WI · On-site +1
$86K - $105K/yr
Ability to assess statistical data and reports related to health service utilization patterns ... Role is 100% remote * Employees may be required to travel to Madison, WI once or twice per year for ...
Madison, WI · On-site +1
$86K - $105K/yr
Ability to assess statistical data and reports related to health service utilization patterns ... Role is 100% remote * Employees may be required to travel to Madison, WI once or twice per year for ...
Madison, WI · On-site +1
$86K - $105K/yr
Ability to assess statistical data and reports related to health service utilization patterns ... Role is 100% remote * Employees may be required to travel to Madison, WI once or twice per year for ...
Madison, WI · On-site +1
$86K - $105K/yr
Ability to assess statistical data and reports related to health service utilization patterns ... Role is 100% remote * Employees may be required to travel to Madison, WI once or twice per year for ...
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
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
Ability to read, review and understand support resources provided by the contact center and its ... Frequent utilization of manual dexterity and visualizing of computer screen * No unusual physical ...
Ability to read, review and understand support resources provided by the contact center and its ... Frequent utilization of manual dexterity and visualizing of computer screen * No unusual physical ...
Ability to read, review and understand support resources provided by the contact center and its ... Frequent utilization of manual dexterity and visualizing of computer screen * No unusual physical ...
Ability to read, review and understand support resources provided by the contact center and its ... Frequent utilization of manual dexterity and visualizing of computer screen * No unusual physical ...
Galesville, WI · On-site +1
$14 - $18/hr
Ability to read, review and understand support resources provided by the contact center and its ... Frequent utilization of manual dexterity and visualizing of computer screen * No unusual physical ...
Galesville, WI · On-site +1
$14 - $18/hr
Ability to read, review and understand support resources provided by the contact center and its ... Frequent utilization of manual dexterity and visualizing of computer screen * No unusual physical ...
Madison, WI · On-site +1
$90K - $135K/yr
Assisting in the management of a cloud-based application platform including utilization ... Remote work requires an approved flexible work arrangement (FWA), which is reviewed and approved ...
Madison, WI · On-site +1
$90K - $135K/yr
Assisting in the management of a cloud-based application platform including utilization ... Remote work requires an approved flexible work arrangement (FWA), which is reviewed and approved ...
Madison, WI · On-site +1
$90K - $135K/yr
Assisting in the management of a cloud-based application platform including utilization ... Remote work requires an approved flexible work arrangement (FWA), which is reviewed and approved ...
Madison, WI · On-site +1
$90K - $135K/yr
Assisting in the management of a cloud-based application platform including utilization ... Remote work requires an approved flexible work arrangement (FWA), which is reviewed and approved ...
$21.59 - $25.96
2% of jobs
$25.96 - $30.33
9% of jobs
$33.32 is the 25th percentile. Wages below this are outliers.
$30.33 - $34.70
21% of jobs
The median wage is $38.23 / hr.
$34.70 - $39.06
23% of jobs
$39.06 - $43.43
13% of jobs
$46.83 is the 75th percentile. Wages above this are outliers.
$43.43 - $47.80
10% of jobs
$47.80 - $52.17
8% of jobs
$52.17 - $56.53
5% of jobs
$56.53 - $60.90
5% of jobs
$60.90 - $65.27
2% of jobs
$65.27 - $69.64
2% of jobs
$21
$42
$69
To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.
A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.
A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 3 days ago
Utilization Review Specialist – Behavioral Health Facility
We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing clinical documentation, ensuring medical necessity, managing insurance authorizations, and collaborating with providers to support appropriate and timely care for our clients.
Responsibilities:
Conduct utilization reviews and obtain prior authorizations from insurance companies
Monitor continued stay and discharge criteria for clients
Communicate effectively with clinical and administrative teams
Maintain accurate and up-to-date documentation
Ensure all documentation meets insurance and regulatory compliance standards and is completed accurately and on time.
Qualifications:
Background or experience in social work, counseling, or behavioral health is preferred
Experience in utilization review or case management for behavioral health is preferred
Strong communication and organization skills
Ability to work efficiently in a fast-paced environment
Confident, proactive, and dedicated work ethic
Benefits: Competitive salary Opportunities for professional development and career advancement Supportive and collaborative work environment Fulfilling work helping individuals with mental health or substance abuse issues
Benefits:
401(k)
Dental insurance
Flexible schedule
Health insurance
Life insurance
Paid time off
Vision insurance
