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Supervisor Utilization Review Remote Jobs in Ohio

Bcbsa

Director, Trade Client Relations

New Hampshire, OH · Remote

$155K - $175K/yr

Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

Bcbsa

Director, Trade Client Relations

Delaware, OH · Remote

$155K - $175K/yr

Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

UnitedHealth Group

Coding Supervisor

Cuyahoga Falls, OH · Remote

$60K - $107K/yr

... the flexibility of a hybrid-remote role as you take on some tough challenges. Primary ... Develop, review, and implement coding policies, departmental procedures, and internal coding ...

New

CareSource

Pharmacist I

Dayton, OH · Remote

$94K - $164K/yr

Formulary Management guidelines, Utilization Management programs, CareSource Administrative and ... PA Reviews for Multi-State Medicaid and Marketplace lines of business Provide written ...

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Supervisor Utilization Review Remote information

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 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.

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 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.
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Supervisor Utilization Review Remote jobs near you

Medical Coding Specialist (remote)

Southwoods Health

Boardman, OH • On-site, Remote

Full-time

Re-posted 21 days ago

Southwoods Health rating

6.3

Company rating: 6.3 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

Job description

Medical Coding Specialist
Southwoods Health | Boardman, OH
Status: Full-Time | Setting: Fully Remote or Fully In-Office
Note: Remote employees must live within a commutable distance from Boardman, OH for initial training.
About the Role
Southwoods Health is seeking a skilled and detail-oriented Medical Coding Specialist. In this role, you will be responsible for the proper assignment of all CPT/HCPCS and ICD-10-CM diagnosis codes to ensure compliant coding across all assigned patient encounters.
Essential Duties
  • Chart Abstraction: Review and abstract evaluation and management (E/M) levels from specialty office or hospital documentation.
  • CPT Coding: Assign accurate CPT codes for surgeries, anesthesia, pain management, and radiology services as required.
  • Physician Queries: Coordinate physician queries within the Meditech system, or contact designated hospital representatives for non-Meditech provider locations.
  • Guidelines & Specificity: Apply a strong understanding of bundling concepts, CMS guidelines, and HCPCS codes to ensure accurate assignment based on Place of Service (POS). Assign ICD-10 codes to the highest level of specificity.
  • Payer Rules & Modifiers: Accurately append modifiers and adhere to distinct guidelines for specific payer groups, including Medicaid HMO and Medicare HMO networks.
  • Quality & Performance: Maintain a minimum 95% coding accuracy rate while consistently meeting established productivity standards.
  • Compliance Framework: Ensure all processes at assigned physician practices maintain strict compliance with all regulatory agencies.
  • Collaborative Support: Research coding inquiries independently, collaborate with supervisors, and perform other duties as assigned.

Qualifications
  • Current medical coding certification (CCS, CCA, CPC, RHIT, COC, ACA, or CIC)
  • Responsible for the proper assignment of all CPT/HCPCS and ICD-10-CM diagnosis codes to ensure compliant coding of documentation provided for physician's offices, specialty offices, hospitalist rounding, in office procedures, other as assigned
  • At least one year in a healthcare setting, 10 or more years of coding experience will be accepted in lieu of a certificate
  • Good Communication skills
  • Working knowledge of Excel
  • Good Computer Skills
  • Strong ethical and moral character references

Why Southwoods?
At Southwoods, it's not just about the treatment, but how you're treated. Join an expanding, award-winning healthcare network that offers flexible work environments and values your specialized professional expertise. #SWH
Apply today at www.southwoodshealth.com.

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