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Supervisor Utilization Review Remote Jobs in Missouri

ChenMed

... systems through the utilization of data demonstrating program effectiveness and success ... record review by the respective delegating physician. * If supporting patients in Tennessee ...

ChenMed

$107K - $136K/yr

... systems through the utilization of data demonstrating program effectiveness and success ... record review by the respective delegating physician. * If supporting patients in Tennessee ...

Parsons

Principal Roadway Engineer

Kansas City, MO · On-site +1

$103K - $181K/yr

Parsons is now hiring a Principal Roadway Engineer to join remote Kansas City team! This is a ... Reviewing work produced to ensure that applicable codes, standards, and procedures are followed and ...

ChenMed

... systems through the utilization of data demonstrating program effectiveness and success ... record review by the respective delegating physician. * If supporting patients in Tennessee ...

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Supervisor Utilization Review Remote information

What does a supervisor utilization review remote do?

A Supervisor Utilization Review (Remote) oversees a team responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients—often for insurance or healthcare organizations. This role ensures that utilization review processes comply with regulatory requirements and organizational standards, while also guiding and supporting staff in their daily activities. Working remotely, the supervisor collaborates with clinicians, case managers, and other stakeholders to facilitate quality patient care and manage healthcare costs. The supervisor may also handle escalated cases and ensure timely completion of reviews.

What are the key skills and qualifications needed to thrive as a supervisor utilization review remote?

To thrive as a Supervisor Utilization Review Remote, you need a solid background in clinical healthcare (often as an RN or similar), experience with utilization management, and knowledge of regulatory guidelines. Familiarity with utilization review software, electronic medical records (EMR), and certifications like CCM or URAC accreditation are typically required. Strong leadership, critical thinking, and effective communication skills help in managing teams and collaborating across departments. These skills ensure efficient review processes, compliance with regulations, and high-quality patient care management in a remote setting.

What are some common challenges faced by remote supervisor utilization review professionals, and how can they be effectively managed?

Remote Supervisor Utilization Review professionals often encounter challenges such as coordinating with distributed team members, ensuring consistent application of review criteria, and maintaining clear communication with both clinical staff and payers. To manage these, it's important to establish regular virtual meetings, utilize secure and efficient digital platforms for case tracking, and foster a culture of transparency and accountability. Additionally, investing time in ongoing training and encouraging peer collaboration can help supervisors stay updated on regulatory changes and best practices.

What is the difference between Supervisor Utilization Review Remote vs Utilization Review Nurse?

AspectSupervisor Utilization Review RemoteUtilization Review Nurse
CredentialsRN license, possibly supervisor certificationRN license, certification in utilization review often preferred
Work EnvironmentRemote, supervisory role overseeing review teamsRemote or onsite, performing case assessments
Employer & IndustryHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare providers

The Supervisor Utilization Review Remote typically oversees review teams and manages processes, requiring leadership skills and certifications. In contrast, Utilization Review Nurses focus on case assessments and approvals, often with similar certifications but less managerial responsibility. Both roles are essential in healthcare utilization management, often working remotely within the same industry.

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Cities in Missouri with the most Supervisor Utilization Review Remote job openings:

Supervisor Utilization Review Remote jobs near you

Revenue Cycle Medical Billing Appeal Resource Utilization Clinical Writer

West Plains, MO • On-site, Remote

Air Evac Lifeteam
Hospitals • 1 - 5K employees
Learn more about Air Evac Lifeteamexternal

$33.65/hr

Full-time

Posted 19 days ago

Job description

More Information about this Job
Revenue Cycle Medical Billing Clinical Appeal Writer
(must currently be a licensed RN)
Location: Remote or On-Site, United States
Hourly Compensation: $33.65
(this position is bonus eligible)
Work Schedule: Full Time
Job Summary
The Clinical Appeal Writer audits medical necessity justification for air transport evaluation and submission of all medical necessity appeals for government payors. They utilize clinical flight experience, established clinical standards and protocols, to validate air medical necessity and appeal payment denials.
Essential Functions/ Duties
  • Conducts audits of the medical necessity appeals for all payor sources in the role of advocate for the patient and GMR.
  • Ensures appeal timelines are met by moving the assigned book of business through the appeals process and updates appeals database.
  • Works with fixed deadlines and demonstrates willingness to meet and exceed performance metrics.
  • Works with the Appeal team to determine the best approach to each clinical denial in order to maximize claim reimbursement and minimize the financial risk to patients and GMR.
  • Maintains strict confidentiality of all protected health information and cooperates fully with all information security guidelines related to the scope of work.

Qualifications
Required Experience
  • Minimum of five years in Emergency department (ED), Intensive Care Unit (ICU), flight or ambulance experience or job experience equivalent
  • Supervisory/leadership experience preferred (i.e.: team leader, FTO, charge nurse, preceptor, educator, etc.)
  • Proficient in Word, Excel, Office 365

Education/Licensure
  • Current RN licensure, is required
  • Bachelor's degree in nursing or equivalent, is preferred
  • CFRN, CEN or CCRN, is preferred

Skills
  • Excellent written communication skills
  • Ability to define and identify problems, collect data, establish facts, and draw valid conclusions
  • Ability to respond to inquiries or complaints from customers in a positive and productive manner
  • Ability to calculate numbers, correct entries, and post to records
  • Ability to gather data from hospital and EMS charts, phone calls, emails, colleagues, and internet research, then compile information and prepare reports and letters
  • Ability to use independent judgment and to manage and impart confidential information
  • Ability to research local EMS protocols, hospital referrals, and standards of care.
  • Ability to review clinical charts and development of constructive feedback

Why Choose Air Evac Lifeteam? As a leader in helicopter air ambulance services, Air Evac Lifeteam is one of Global Medical Response's (GMR) family of solutions. Our GMR teams deliver compassionate, quality medical care, primarily in the areas of emergency and patient relocation services. View the stories on how our employees provide care to the world at www.AtaMomentsNotice.com.
GMR's Core Behaviors-keep care at the center, raise your hand, seek to understand, find a way together and be accountable-unite our teams and set us apart in emergency medical services.
EEO Statement
Global Medical Response and its family of companies are an Equal Opportunity Employer, which includes supporting veterans and providing reasonable accommodations for individuals with a disability.
More Information about this Job
Check out our careers site benefits page to learn more about our benefit options.

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