... Therapy and Nursing. Summary: Works with the Utilization Management team primarily responsible for ... Provides daily review and evaluation of members that require hospitalization and/or procedures ...
... Therapy and Nursing. Summary: Works with the Utilization Management team primarily responsible for ... Provides daily review and evaluation of members that require hospitalization and/or procedures ...
Quality Assurance Behavioral Health
$35.25 - $47.25/hr
... evidence-based therapies. Guided by our core values--Compassion, Curiosity, Excellence, and ... The ideal candidate has a strong clinical or utilization review background, a deep understanding of ...
Quality Assurance Behavioral Health
$35.25 - $47.25/hr
... evidence-based therapies. Guided by our core values--Compassion, Curiosity, Excellence, and ... The ideal candidate has a strong clinical or utilization review background, a deep understanding of ...
Provide physical therapy services to patients as directed by the patient care plan and supervised ... Utilization Review, Quality Assurance, Program Evaluation, Infection Control, and Safety Committee ...
Provide physical therapy services to patients as directed by the patient care plan and supervised ... Utilization Review, Quality Assurance, Program Evaluation, Infection Control, and Safety Committee ...
Telephonic Case Manager
Boca Raton, FL · On-site
Responsible for the performance of Utilization Review services, including pre-admission ... Works with the physicians and therapists to set up medical assessments to develop an overall ...
Telephonic Case Manager
Boca Raton, FL · On-site
Responsible for the performance of Utilization Review services, including pre-admission ... Works with the physicians and therapists to set up medical assessments to develop an overall ...
Responsible for the performance of Utilization Review services, including pre-admission ... Works with the physicians and therapists to set up medical assessments to develop an overall ...
Responsible for the performance of Utilization Review services, including pre-admission ... Works with the physicians and therapists to set up medical assessments to develop an overall ...
Telephonic Case Manager
Boca Raton, FL · On-site
Responsible for the performance of Utilization Review services, including pre-admission ... Explains physician's and therapists' instructions, and answers any other questions the claimant may ...
Telephonic Case Manager
Boca Raton, FL · On-site
Responsible for the performance of Utilization Review services, including pre-admission ... Explains physician's and therapists' instructions, and answers any other questions the claimant may ...
PTA - Physical Therapist Assistant - Nassau Rehab
Jacksonville, FL · On-site
$27 - $32/hr
Provide physical therapy services to patients as directed by the patient care plan and supervised ... Utilization Review, Quality Assurance, Program Evaluation, Infection Control, and Safety Committee ...
Quick apply
PTA - Physical Therapist Assistant - Nassau Rehab
Jacksonville, FL · On-site
$27 - $32/hr
Provide physical therapy services to patients as directed by the patient care plan and supervised ... Utilization Review, Quality Assurance, Program Evaluation, Infection Control, and Safety Committee ...
Participates in the utilization review, quality improvement and interdisciplinary conference of the ... Physical Therapy preferredNecessary Skills:1. Competency in the provision of physical therapy. 2. ...
Participates in the utilization review, quality improvement and interdisciplinary conference of the ... Physical Therapy preferredNecessary Skills:1. Competency in the provision of physical therapy. 2. ...
Participates in the utilization review, quality improvement and interdisciplinary conference of the ... Physical Therapy preferred Necessary Skills: 1. Competency in the provision of physical therapy. 2. ...
Participates in the utilization review, quality improvement and interdisciplinary conference of the ... Physical Therapy preferred Necessary Skills: 1. Competency in the provision of physical therapy. 2. ...
Physical Therapist Assistant
$26 - $34.25/hr
Provide physical therapy services to patients as directed by the patient care plan and supervised ... Utilization Review, Quality Assurance, Program Evaluation, Infection Control, and Safety Committee ...
Physical Therapist Assistant
$26 - $34.25/hr
Provide physical therapy services to patients as directed by the patient care plan and supervised ... Utilization Review, Quality Assurance, Program Evaluation, Infection Control, and Safety Committee ...
Physical Therapist Assistant
$26 - $34.25/hr
Provide physical therapy services to patients as directed by the patient care plan and supervised ... Utilization Review, Quality Assurance, Program Evaluation, Infection Control, and Safety Committee ...
Physical Therapist Assistant
$26 - $34.25/hr
Provide physical therapy services to patients as directed by the patient care plan and supervised ... Utilization Review, Quality Assurance, Program Evaluation, Infection Control, and Safety Committee ...
Physical Therapist Assistant
Jacksonville, FL · On-site
$53.50K - $65K/yr
Provide physical therapy services to patients as directed by the patient care plan and supervised ... Utilization Review, Quality Assurance, Program Evaluation, Infection Control, and Safety Committee ...
Quick apply
Physical Therapist Assistant
Jacksonville, FL · On-site
$53.50K - $65K/yr
Provide physical therapy services to patients as directed by the patient care plan and supervised ... Utilization Review, Quality Assurance, Program Evaluation, Infection Control, and Safety Committee ...
Physical Therapist Assistant
Jacksonville, FL · On-site
$25.50 - $33.75/hr
Provide physical therapy services to patients as directed by the patient care plan and supervised ... Utilization Review, Quality Assurance, Program Evaluation, Infection Control, and Safety Committee ...
Quick apply
Physical Therapist Assistant
Jacksonville, FL · On-site
$25.50 - $33.75/hr
Provide physical therapy services to patients as directed by the patient care plan and supervised ... Utilization Review, Quality Assurance, Program Evaluation, Infection Control, and Safety Committee ...
Three (3) to five (5) years' experience in chart analysis and utilization review in the psychiatric and chemical dependency filed preferred. * Valid FL license, e.g., RN, LSCW, LMHC or LMFT preferred.
Three (3) to five (5) years' experience in chart analysis and utilization review in the psychiatric and chemical dependency filed preferred. * Valid FL license, e.g., RN, LSCW, LMHC or LMFT preferred.
Three (3) to five (5) years' experience in chart analysis and utilization review in the psychiatric and chemical dependency filed preferred. * Valid FL license, e.g., RN, LSCW, LMHC or LMFT preferred.
Three (3) to five (5) years' experience in chart analysis and utilization review in the psychiatric and chemical dependency filed preferred. * Valid FL license, e.g., RN, LSCW, LMHC or LMFT preferred.
Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. License and ... Reviews health care services to determine consistency with contract requirements, coverage policies ...
Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. License and ... Reviews health care services to determine consistency with contract requirements, coverage policies ...
Medical Records Reviewer
Fort Lauderdale, FL · On-site
$16.25 - $19.25/hr
Minimum of 1 year of experience working with clinical records, medical documentation, or utilization review, preferably in ABA therapy, behavioral health, or healthcare settings. * Proven experience ...
Quick apply
Medical Records Reviewer
Fort Lauderdale, FL · On-site
$16.25 - $19.25/hr
Minimum of 1 year of experience working with clinical records, medical documentation, or utilization review, preferably in ABA therapy, behavioral health, or healthcare settings. * Proven experience ...
Medical Records Reviewer
Lauderdale Lakes, FL · On-site
$16.25 - $19.25/hr
Minimum of 1 year of experience working with clinical records, medical documentation, or utilization review, preferably in ABA therapy, behavioral health, or healthcare settings. * Proven experience ...
Medical Records Reviewer
Lauderdale Lakes, FL · On-site
$16.25 - $19.25/hr
Minimum of 1 year of experience working with clinical records, medical documentation, or utilization review, preferably in ABA therapy, behavioral health, or healthcare settings. * Proven experience ...
Medical Records Reviewer
Lauderdale Lakes, FL · On-site
$17 - $20.25/hr
Minimum of 1 year of experience working with clinical records, medical documentation, or utilization review, preferably in ABA therapy, behavioral health, or healthcare settings. * Proven experience ...
Medical Records Reviewer
Lauderdale Lakes, FL · On-site
$17 - $20.25/hr
Minimum of 1 year of experience working with clinical records, medical documentation, or utilization review, preferably in ABA therapy, behavioral health, or healthcare settings. * Proven experience ...
Financial Counselor
$18.50 - $24/hr
... therapies. Guided by our core values-- Compassion, Excellence, and Innovation --we provide ... The Financial Counselor works closely with Admissions, Utilization Review, and Billing teams to ...
Financial Counselor
$18.50 - $24/hr
... therapies. Guided by our core values-- Compassion, Excellence, and Innovation --we provide ... The Financial Counselor works closely with Admissions, Utilization Review, and Billing teams to ...
Therapy Utilization Review information
What are the key skills and qualifications needed to thrive as a Therapy Utilization Review specialist, and why are they important?
To thrive as a Therapy Utilization Review specialist, you need a solid background in clinical therapy practice (such as physical, occupational, or speech therapy), often supported by licensure and clinical experience. Familiarity with medical review software, electronic health records (EHRs), and utilization management systems is typically required, along with knowledge of insurance guidelines and regulatory standards. Strong analytical thinking, attention to detail, and clear communication skills help professionals effectively assess treatment plans and collaborate with both providers and payers. These skills and qualities are essential for ensuring that patients receive medically necessary, cost-effective therapy while maintaining compliance with regulations.
What are some common challenges faced by professionals in Therapy Utilization Review, and how can they be managed?
One of the main challenges in Therapy Utilization Review is balancing the clinical needs of patients with insurance guidelines and organizational policies. Professionals often need to make difficult decisions about treatment approvals while communicating effectively with both therapists and insurance providers. Staying current on clinical guidelines, maintaining strong documentation skills, and developing firm but empathetic communication abilities can help manage these challenges. Collaboration with interdisciplinary teams is also essential to ensure patients receive appropriate care while meeting regulatory requirements.
What is Therapy Utilization Review?
Therapy Utilization Review is a process used by healthcare organizations and insurance companies to evaluate the necessity, efficiency, and appropriateness of therapy services being provided to patients. This review ensures that treatments such as physical, occupational, or speech therapy are medically necessary and align with established guidelines. The goal is to optimize patient care while managing costs and preventing overuse or misuse of therapy services. Professionals in this role review patient records, treatment plans, and progress notes, often collaborating with therapists and other healthcare providers.
What is the difference between Therapy Utilization Review vs Speech-Language Pathologist?
| Aspect | Therapy Utilization Review | Speech-Language Pathologist |
|---|---|---|
| Credentials | Typically requires healthcare or insurance-related certifications | Requires a master's degree in speech-language pathology and state licensure |
| Work Environment | Insurance companies, healthcare organizations, or utilization review departments | Hospitals, clinics, schools, or private practice |
| Industry Usage | Focuses on evaluating therapy necessity and coverage | Provides direct therapy services to patients with speech or language disorders |
While Therapy Utilization Review involves assessing the necessity of therapy services for insurance coverage, Speech-Language Pathologists provide direct patient care. Both roles require healthcare knowledge, but they differ in focus: one is review-based, the other is clinical service delivery.
What are popular job titles related to Therapy Utilization Review jobs in Florida? For Therapy Utilization Review jobs in Florida, the most frequently searched job titles are:
- Medical Claim Review Nurse
- Remote Chart Review Nurse
- Evening Utilization Review Nurse
- Appeals Nurse Remote
- Utilization Management Nurse Consultant
- Work From Home Rn Legal Nurse Chart Review
- Evening Optum Health Utilization Review
- No Experience Utilization Review Nurse
- Contract Utilization Review Nurse
- Weekday Cvs Utilization Management Nurse
What job categories do people searching Therapy Utilization Review jobs in Florida look for? The top searched job categories for Therapy Utilization Review jobs in Florida are:
- Remote Nicu Utilization Review
- Remote Supervisor Utilization Management
- Freelance International Utilization Review Nurse
- Remote Anthem Utilization Review Nurse
- Full Time Cigna Utilization Review Nurse
- Remote Authorization Utilization Review Bcba
- Seasonal Remote Utilization Review
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- Work From Home Dental Utilization Review
- Utilization Review Management
What cities in Florida are hiring for Therapy Utilization Review jobs? Cities in Florida with the most Therapy Utilization Review job openings:
Job description
Company Description
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Job Description
Summary: Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. Essential Functions: Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization Management team. Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures. Participates in interdepartmental integration and collaboration to enhance the continuity of care for members including Behavioral Health and Long Term Care. Maintains department productivity and quality measures. Attends regular staff meetings. Assists with mentoring of new team members. Completes assigned work plan objectives and projects on a timely basis. Maintains professional relationships with provider community and internal and external customers. Conducts self in a professional manner at all times. Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. Consults with and refers cases to medical directors regularly, as necessary. Complies with required workplace safety standards. Knowledge/Skills/Abilities: Demonstrated ability to communicate, problem solve, and work effectively with people. Excellent organizational skill with the ability to manage multiple priorities. Work independently and handle multiple projects simultaneously. Knowledge of applicable state, and federal regulations. In depth knowledge of Interqual and other references for length of stay and medical necessity determinations. Experience with NCQA. Ability to take initiative and see tasks to completion. Computer Literate (Microsoft Office Products). Excellent verbal and written communication skills. Ability to abide by policies. Ability to maintain attendance to support required quality and quantity of work. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Skilled at establishing and maintaining positive and effective work relationships with co-workers, clients, members, providers and customers. Required Education: Completion of an accredited Registered Nursing program. (a combination of experience and education will be considered in lieu of Registered Nursing degree). Required Experience: Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management. Required Licensure/Certification: Active, unrestricted State Nursing (RN, LVN, LPN) license in good standing.
Qualifications
Experience: Must have at least 1 year of utilization management experience. UM experience can be outpatient and have worked at any healthcare facility or healthcare insurance company.
Required License: LPN, or RN, must be a FL state license.
Must Haves:
Interqual or Millimen
Utilization Management experience
Additional Information
Riya Khem
Life Science Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I
DIRECT # - 732 -844-8721 | (W) # 732-549-2030 - Ext - 311 |(F) 732-549-5549
About Integrated Resources
Sourced by ZipRecruiter
Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.
Industry
Recruiting and staffing services
Company size
51 - 200 Employees
Headquarters location
Edison, NJ, US
Year founded
1996