Pre Access Specialist
Akron, OH · On-site +1
... case management, utilization review, and clinical teams to gather necessary information and ... Remote
Pre Access Specialist
Akron, OH · On-site +1
... case management, utilization review, and clinical teams to gather necessary information and ... Remote
Remote Prior Authorization Pharmacist
Cleveland, OH · Remote
$56.50 - $68/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Remote Prior Authorization Pharmacist
Cleveland, OH · Remote
$56.50 - $68/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Remote Prior Authorization Pharmacist
Columbus, OH · Remote
$56.25 - $67.50/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Remote Prior Authorization Pharmacist
Columbus, OH · Remote
$56.25 - $67.50/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
RN Hospice Workflow Specialist/ Weekend Manager REMOTE
Cincinnati, OH · Remote
$71K - $89K/yr
Review and prioritize incoming referrals, physician orders, and clinical documentation. * Monitor ... Remote position. * Primarily weekend coverage (Saturday and Sunday), with flexibility for holidays ...
Quick apply
RN Hospice Workflow Specialist/ Weekend Manager REMOTE
Cincinnati, OH · Remote
$71K - $89K/yr
Review and prioritize incoming referrals, physician orders, and clinical documentation. * Monitor ... Remote position. * Primarily weekend coverage (Saturday and Sunday), with flexibility for holidays ...
Appeals Pharmacist (Remote)
Cleveland, OH · On-site +1
$55.50 - $67.75/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Appeals Pharmacist (Remote)
Cleveland, OH · On-site +1
$55.50 - $67.75/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Appeals Pharmacist (Remote)
Columbus, OH · On-site +1
$55.25 - $67.25/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Appeals Pharmacist (Remote)
Columbus, OH · On-site +1
$55.25 - $67.25/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Clinical Therapist- Group & Individual- Remote
Toledo, OH · On-site +1
$401K/yr
Collaborate with psychiatry, medical providers, case management, peer recovery support, admissions, utilization review, and leadership staff to ensure continuity and coordination of care.
Clinical Therapist- Group & Individual- Remote
Toledo, OH · On-site +1
$401K/yr
Collaborate with psychiatry, medical providers, case management, peer recovery support, admissions, utilization review, and leadership staff to ensure continuity and coordination of care.
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
Accounting Associate - Remote
Toledo, OH · Remote
$60K - $100K/yr
... review. • Maintain and optimize financial data within Google Sheets for better reporting and ... for weekend or extended hours as needed to meet business demands. Required Skills and ...
Accounting Associate - Remote
Toledo, OH · Remote
$60K - $100K/yr
... review. • Maintain and optimize financial data within Google Sheets for better reporting and ... for weekend or extended hours as needed to meet business demands. Required Skills and ...
Accounting Associate - Remote
Cincinnati, OH · Remote
$60K - $100K/yr
... review. • Maintain and optimize financial data within Google Sheets for better reporting and ... for weekend or extended hours as needed to meet business demands. Required Skills and ...
Accounting Associate - Remote
Cincinnati, OH · Remote
$60K - $100K/yr
... review. • Maintain and optimize financial data within Google Sheets for better reporting and ... for weekend or extended hours as needed to meet business demands. Required Skills and ...
Accounting Associate - Remote
Columbus, OH · Remote
$60K - $100K/yr
... review. • Maintain and optimize financial data within Google Sheets for better reporting and ... for weekend or extended hours as needed to meet business demands. Required Skills and ...
Accounting Associate - Remote
Columbus, OH · Remote
$60K - $100K/yr
... review. • Maintain and optimize financial data within Google Sheets for better reporting and ... for weekend or extended hours as needed to meet business demands. Required Skills and ...
Accounting Associate - Remote
Cleveland, OH · Remote
$60K - $100K/yr
... review. • Maintain and optimize financial data within Google Sheets for better reporting and ... for weekend or extended hours as needed to meet business demands. Required Skills and ...
Accounting Associate - Remote
Cleveland, OH · Remote
$60K - $100K/yr
... review. • Maintain and optimize financial data within Google Sheets for better reporting and ... for weekend or extended hours as needed to meet business demands. Required Skills and ...
Accounting Associate - Remote
Akron, OH · Remote
$60K - $100K/yr
... review. • Maintain and optimize financial data within Google Sheets for better reporting and ... for weekend or extended hours as needed to meet business demands. Required Skills and ...
Accounting Associate - Remote
Akron, OH · Remote
$60K - $100K/yr
... review. • Maintain and optimize financial data within Google Sheets for better reporting and ... for weekend or extended hours as needed to meet business demands. Required Skills and ...
Accounting Associate - Remote
Dayton, OH · Remote
$60K - $100K/yr
... review. • Maintain and optimize financial data within Google Sheets for better reporting and ... for weekend or extended hours as needed to meet business demands. Required Skills and ...
Accounting Associate - Remote
Dayton, OH · Remote
$60K - $100K/yr
... review. • Maintain and optimize financial data within Google Sheets for better reporting and ... for weekend or extended hours as needed to meet business demands. Required Skills and ...
... weekend clinical calls. He/She is accountable for assessing, diagnosing, treating and precisely ... systems through the utilization of data demonstrating program effectiveness and success.
... weekend clinical calls. He/She is accountable for assessing, diagnosing, treating and precisely ... systems through the utilization of data demonstrating program effectiveness and success.
Supervisor, Support Administration
Cleveland, OH · On-site +1
... Administrative Review, and utilization of Medicaid State Plan Services. Deliver technical ... Remote Work: Our positions are not 100'% remote. There is an onsite expectation for all of our ...
Supervisor, Support Administration
Cleveland, OH · On-site +1
... Administrative Review, and utilization of Medicaid State Plan Services. Deliver technical ... Remote Work: Our positions are not 100'% remote. There is an onsite expectation for all of our ...
Supervisor, Support Administration
Cleveland, OH · On-site +1
... Administrative Review, and utilization of Medicaid State Plan Services. Deliver technical ... Remote Work: Our positions are not 100'% remote. There is an onsite expectation for all of our ...
Supervisor, Support Administration
Cleveland, OH · On-site +1
... Administrative Review, and utilization of Medicaid State Plan Services. Deliver technical ... Remote Work: Our positions are not 100'% remote. There is an onsite expectation for all of our ...
Pharmacy Claims Representative 2 - Remote
West Chester, OH · On-site +1
$22/hr
Monday - Friday, 2:30PM - 11:00PM EST & every 4th weekend rotation Compensation: $22.00/HR + 12 ... In a remote call center environment, you will review, analyze, and process pharmacy claims with ...
Pharmacy Claims Representative 2 - Remote
West Chester, OH · On-site +1
$22/hr
Monday - Friday, 2:30PM - 11:00PM EST & every 4th weekend rotation Compensation: $22.00/HR + 12 ... In a remote call center environment, you will review, analyze, and process pharmacy claims with ...
Pharmacy Claims Representative 2 - Remote
West Chester, OH · Remote
$22/hr
Monday - Friday, 2:30PM - 11:00PM EST & every 4th weekend rotation Compensation: $22.00/HR + 12 ... In a remote call center environment, you will review, analyze, and process pharmacy claims with ...
Pharmacy Claims Representative 2 - Remote
West Chester, OH · Remote
$22/hr
Monday - Friday, 2:30PM - 11:00PM EST & every 4th weekend rotation Compensation: $22.00/HR + 12 ... In a remote call center environment, you will review, analyze, and process pharmacy claims with ...
Remote Weekend Utilization Review information
What is the difference between Remote Weekend Utilization Review vs Remote Weekday Utilization Review?
| Aspect | Remote Weekend Utilization Review | Remote Weekday Utilization Review |
|---|---|---|
| Credentials | Typically requires a healthcare professional license and utilization review certification | Same as weekend role, healthcare license and utilization review certification |
| Work Environment | Remote, weekend hours, often part-time or flexible | Remote, weekday hours, standard business hours |
| Employer & Industry | Health insurance companies, third-party administrators | Same as weekend role, health insurance industry |
| Work Schedule | Primarily weekends, possibly evenings | Weekdays, regular business hours |
Remote Weekend Utilization Review and Remote Weekday Utilization Review roles are similar in credentials and industry but differ mainly in work schedule. Weekend roles focus on reviewing cases during weekends, offering flexibility, while weekday roles follow standard business hours. Both positions require healthcare licensing and utilization review certification, serving health insurance companies and third-party administrators.
What cities in Ohio are hiring for Remote Weekend Utilization Review jobs? Cities in Ohio with the most Remote Weekend Utilization Review job openings:
Full-time
Posted 29 days ago
Akron Children's Hospital rating
7.3
Based on 93 frontline employees who took The Breakroom Quiz
354th of 1,002 rated hospitals
Job description
Full-time, 40 hours/week
Monday-Friday 11:30am-8pm or 11am-7:30pm
Remote- must be within commutable distance from Mahoning Valley location for 30-60 days onsite training
Summary:
Pre Access Specialist is responsible for performing functions to facilitate the patient's seamless movement through the Revenue Cycle process. This role ensures demographic and insurance requirements are current, supports reimbursement processes, and minimizes claim denials by verifying coverage and communicating details downstream accurately and efficiently.
Responsibilities:
1. Manage Epic work queues and reports for Pre-Access tasks; to make outbound calls or send communications to patients and/or responsibility parties to collect information to update Epic and/or share information within required timeframes, etc.
2. Register complete and accurate demographic, guarantor and financial information to create the patient's record in the system for billing purposes.
3. Verify patient insurance coverage and eligibility using electronic systems or payer portals or phone calls.
4. Process, triage and document incoming calls, voicemails, faxes, and/or emails per standard protocols in the appropriate system or tool.
5. Apply approved scripting for patient interactions and handle unique scenarios professionally.
6. Collaborate with Patient Access team members, clinical departments, case management, utilization review, and clinical teams to gather necessary information and expedite services when needed.
7. Escalate issues related to coverage, status, denials, delays or repeated trends to leadership for review.
8. Create and send estimates as needed or refer cases to Financial Counseling when potential for patient liability exists.
9. Meet departmental standards for productivity, quality, and timeliness.
10. Other Duties as assigned
Other information:
Technical Expertise
1. Knowledge of medical terminology, CPT/ICD-10 codes, and pediatric insurance benefits
2. Strong interpersonal communication skills to support families with empathy and clarity
3. Ability to navigate multiple systems (EHR, payer portals); Epic experience preferred
4. Strong understanding of insurance types (Medicare, Medicaid, commercial, managed care)
5. Excellent communication, organizational, and time management skills
6. Ability to work independently in a fast-paced environment.
7. Familiarity with EHR systems (e.g., Epic, Cerner) and payer portals and guidelines (i.e. Medicaid, managed care, and commercial plans)
Education and Experience
1. High school diploma or equivalent required; associate degree or healthcare certification preferred.
2. Minimum 1 year in a Clinical, Revenue Cycle, Patient Access or Insurance company role that perform work related to; registration, insurance verification, billing, scheduling, patient service rep, customer service, etc. required.
3. Pediatric healthcare access roles preferred.
4. Certification in healthcare access (e.g., CHAA or CMAA) preferred.
5. Experience in hospital admissions or emergency department settings preferred.
• Familiarity with pediatric insurance policies, including Medicaid, managed care, and commercial plans preferred.
Full Time
FTE: 1.000000
Status: Remote
Monday-Friday 11:30am-8pm or 11am-7:30pm
Remote- must be within commutable distance from Mahoning Valley location for 30-60 days onsite training
Summary:
Pre Access Specialist is responsible for performing functions to facilitate the patient's seamless movement through the Revenue Cycle process. This role ensures demographic and insurance requirements are current, supports reimbursement processes, and minimizes claim denials by verifying coverage and communicating details downstream accurately and efficiently.
Responsibilities:
1. Manage Epic work queues and reports for Pre-Access tasks; to make outbound calls or send communications to patients and/or responsibility parties to collect information to update Epic and/or share information within required timeframes, etc.
2. Register complete and accurate demographic, guarantor and financial information to create the patient's record in the system for billing purposes.
3. Verify patient insurance coverage and eligibility using electronic systems or payer portals or phone calls.
4. Process, triage and document incoming calls, voicemails, faxes, and/or emails per standard protocols in the appropriate system or tool.
5. Apply approved scripting for patient interactions and handle unique scenarios professionally.
6. Collaborate with Patient Access team members, clinical departments, case management, utilization review, and clinical teams to gather necessary information and expedite services when needed.
7. Escalate issues related to coverage, status, denials, delays or repeated trends to leadership for review.
8. Create and send estimates as needed or refer cases to Financial Counseling when potential for patient liability exists.
9. Meet departmental standards for productivity, quality, and timeliness.
10. Other Duties as assigned
Other information:
Technical Expertise
1. Knowledge of medical terminology, CPT/ICD-10 codes, and pediatric insurance benefits
2. Strong interpersonal communication skills to support families with empathy and clarity
3. Ability to navigate multiple systems (EHR, payer portals); Epic experience preferred
4. Strong understanding of insurance types (Medicare, Medicaid, commercial, managed care)
5. Excellent communication, organizational, and time management skills
6. Ability to work independently in a fast-paced environment.
7. Familiarity with EHR systems (e.g., Epic, Cerner) and payer portals and guidelines (i.e. Medicaid, managed care, and commercial plans)
Education and Experience
1. High school diploma or equivalent required; associate degree or healthcare certification preferred.
2. Minimum 1 year in a Clinical, Revenue Cycle, Patient Access or Insurance company role that perform work related to; registration, insurance verification, billing, scheduling, patient service rep, customer service, etc. required.
3. Pediatric healthcare access roles preferred.
4. Certification in healthcare access (e.g., CHAA or CMAA) preferred.
5. Experience in hospital admissions or emergency department settings preferred.
• Familiarity with pediatric insurance policies, including Medicaid, managed care, and commercial plans preferred.
Full Time
FTE: 1.000000
Status: Remote
What Akron Children's Hospital employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Akron Children's Hospital
Sourced by ZipRecruiter
Akron Children's Hospital has been caring for children since 1890, and our pediatric specialties are ranked among the nation's best by U.S. News & World Report. With two hospital campuses, regional health centers and more than 50 primary and specialty care locations throughout Ohio, we're making it easier for today's busy families to find the high-quality care they need. In 2020, our health care system provided more than 1.1 million patient encounters. We also operate neonatal and pediatric units in the hospitals of our regional health care partners. Every year, our Children's Home Care Group nurses provide thousands of in-home visits, and our School Health nurses manage clinic visits for students from preschool through high school. With our Quick Care Online virtual visits and Akron Children's Anywhere app, we're here for families whenever and wherever they need us. Learn more at akronchildrens.org.
Industry
Hospitals
Company size
5,001 - 10,000 Employees
Headquarters location
Akron, OH, US
Year founded
1890