Health Plan Referral Specialist - HP Utilization Management US:TX:Irving | Health Plans | Full Time ... Associate's degree or higher in allied health professional field of study, preferred * Working ...
Health Plan Referral Specialist - HP Utilization Management US:TX:Irving | Health Plans | Full Time ... Associate's degree or higher in allied health professional field of study, preferred * Working ...
This role enables associates to work virtually full-time, with the exception of required in-person ... Responsibilities exclude conducting any utilization management review activities which require ...
This role enables associates to work virtually full-time, with the exception of required in-person ... Responsibilities exclude conducting any utilization management review activities which require ...
This role enables associates to work virtually full-time, with the exception of required in-person ... Responsibilities exclude conducting any utilization management review activities which require ...
This role enables associates to work virtually full-time, with the exception of required in-person ... Responsibilities exclude conducting any utilization management review activities which require ...
The Axis Field Operations Management Associate - Well Servicing is an entry-level, high-potential ... flow, equipment utilization, rig-up/rig-down expectations, and customer delivery standards.
The Axis Field Operations Management Associate - Well Servicing is an entry-level, high-potential ... flow, equipment utilization, rig-up/rig-down expectations, and customer delivery standards.
The Axis Field Operations Management Associate - Well Servicing is an entry-level, high-potential ... flow, equipment utilization, rig-up/rig-down expectations, and customer delivery standards.
Quick apply
The Axis Field Operations Management Associate - Well Servicing is an entry-level, high-potential ... flow, equipment utilization, rig-up/rig-down expectations, and customer delivery standards.
The Axis Field Operations Management Associate - Well Servicing is an entry-level, high-potential ... flow, equipment utilization, rig-up/rig-down expectations, and customer delivery standards.
The Axis Field Operations Management Associate - Well Servicing is an entry-level, high-potential ... flow, equipment utilization, rig-up/rig-down expectations, and customer delivery standards.
The Axis Field Operations Management Associate - Well Servicing is an entry-level, high-potential ... flow, equipment utilization, rig-up/rig-down expectations, and customer delivery standards.
Quick apply
The Axis Field Operations Management Associate - Well Servicing is an entry-level, high-potential ... flow, equipment utilization, rig-up/rig-down expectations, and customer delivery standards.
Wealth Management Associate participants partner with Financial Advisors in a branch or complex to ... brand utilization of the resources in the branch or complex. • Learn and practice client ...
Wealth Management Associate participants partner with Financial Advisors in a branch or complex to ... brand utilization of the resources in the branch or complex. • Learn and practice client ...
Wealth Management Associate participants partner with Financial Advisors in a branch or complex to ... brand utilization of the resources in the branch or complex. • Learn and practice client ...
Wealth Management Associate participants partner with Financial Advisors in a branch or complex to ... brand utilization of the resources in the branch or complex. • Learn and practice client ...
Associate's degree or higher in allied health professional field of study, preferred * Working ... physician office, or managed care organization, preferred Licenses, Registrations, or ...
Associate's degree or higher in allied health professional field of study, preferred * Working ... physician office, or managed care organization, preferred Licenses, Registrations, or ...
Active, unencumbered Registered Nurse with an associate degree or must be state-licensed practical ... Experience: Requires at least 5 years' experience in Managed Care, and Utilization Management.
Active, unencumbered Registered Nurse with an associate degree or must be state-licensed practical ... Experience: Requires at least 5 years' experience in Managed Care, and Utilization Management.
Associate's degree or higher in allied health professional field of study, preferred * Working ... physician office, or managed care organization, preferred Licenses, Registrations, or ...
Associate's degree or higher in allied health professional field of study, preferred * Working ... physician office, or managed care organization, preferred Licenses, Registrations, or ...
Active, unencumbered Registered Nurse with an associate degree or must be state-licensed practical ... Experience: Requires at least 5 years' experience in Managed Care, and Utilization Management.
Active, unencumbered Registered Nurse with an associate degree or must be state-licensed practical ... Experience: Requires at least 5 years' experience in Managed Care, and Utilization Management.
UM Nurse
San Antonio, TX · On-site
Active, unencumbered Registered Nurse with an associate degree or must be state-licensed practical ... Experience: Requires at least 5 years' experience in Managed Care, and Utilization Management.
UM Nurse
San Antonio, TX · On-site
Active, unencumbered Registered Nurse with an associate degree or must be state-licensed practical ... Experience: Requires at least 5 years' experience in Managed Care, and Utilization Management.
UM Nurse
San Antonio, TX · On-site
Active, unencumbered Registered Nurse with an associate degree or must be state-licensed practical ... Experience: Requires at least 5 years' experience in Managed Care, and Utilization Management.
UM Nurse
San Antonio, TX · On-site
Active, unencumbered Registered Nurse with an associate degree or must be state-licensed practical ... Experience: Requires at least 5 years' experience in Managed Care, and Utilization Management.
Position Overview The Associate Medical Director will take a hands-on approach in supporting and overseeing clinical activities across utilization management, quality initiatives, pharmacy ...
Position Overview The Associate Medical Director will take a hands-on approach in supporting and overseeing clinical activities across utilization management, quality initiatives, pharmacy ...
Updating Clinical Resource Manager as needed. * Assigning daily tasks to staff members to ensure ... EDUCATION - Associate's Degree * MAJOR - Nursing * EXPERIENCE - (4) Four Years of Experience
Updating Clinical Resource Manager as needed. * Assigning daily tasks to staff members to ensure ... EDUCATION - Associate's Degree * MAJOR - Nursing * EXPERIENCE - (4) Four Years of Experience
UM Nurse
San Antonio, TX · On-site
Active, unencumbered Registered Nurse with an associate degree or must be state-licensed practical ... Experience: Requires at least 5 years' experience in Managed Care, and Utilization Management.
UM Nurse
San Antonio, TX · On-site
Active, unencumbered Registered Nurse with an associate degree or must be state-licensed practical ... Experience: Requires at least 5 years' experience in Managed Care, and Utilization Management.
... energize associates to work together for change; gains maximum support form others for new ... Managing Process: Translates strategies into action steps; clearly assigns responsibility for ...
... energize associates to work together for change; gains maximum support form others for new ... Managing Process: Translates strategies into action steps; clearly assigns responsibility for ...
... energize associates to work together for change; gains maximum support form others for new ... Managing Process: Translates strategies into action steps; clearly assigns responsibility for ...
... energize associates to work together for change; gains maximum support form others for new ... Managing Process: Translates strategies into action steps; clearly assigns responsibility for ...
Utilization Management Associate information
What does a utilization management associate do?
A Utilization Management Associate is responsible for reviewing healthcare services and determining whether they are medically necessary, appropriate, and efficient. They work with healthcare providers, insurance companies, and patients to ensure that treatments comply with established guidelines and policies. Their role often includes reviewing medical records, processing authorizations, and assisting in the coordination of care to optimize the use of healthcare resources. This position helps control costs while ensuring that patients receive the appropriate level of care.
What skills and qualifications are needed to thrive as a utilization management associate?
A Utilization Management Associate typically needs a background in healthcare administration or a related field, strong analytical skills, and knowledge of medical terminology and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and regulatory compliance systems is important, and certifications like Certified Professional in Healthcare Management (CPHM) can be advantageous. Attention to detail, effective communication, and strong organizational skills help associates excel in evaluating medical necessity and collaborating with care teams. These competencies ensure accurate, efficient review processes that support quality patient care and compliance with payer requirements.
What are the typical daily responsibilities of a utilization management associate?
Utilization Management Associates typically review medical records, verify insurance coverage, and coordinate with healthcare providers to ensure that treatments and services meet established guidelines and payer requirements. They also communicate with physicians and patients to gather necessary information for authorization requests. By ensuring appropriate utilization of healthcare resources, they help support patient care while managing costs and compliance for their organization. Collaboration with clinical staff and insurance representatives is a key part of the role, contributing to effective case management.
What is the difference between Utilization Management Associate vs Utilization Review Coordinator?
| Aspect | Utilization Management Associate | Utilization Review Coordinator |
|---|---|---|
| Certifications | Typically requires a healthcare-related certification or license | Often requires similar certifications, such as CCM or RHIA |
| Work Environment | Works in insurance companies, healthcare providers, or managed care organizations | Works in hospitals, insurance companies, or healthcare facilities |
| Job Focus | Assists in reviewing medical necessity and authorization processes | Coordinates and conducts utilization reviews and approvals |
| Common Usage | Used interchangeably in healthcare and insurance settings | Often used in hospital and insurance contexts |
The Utilization Management Associate and Utilization Review Coordinator roles share similarities in certifications and work environments, focusing on reviewing medical necessity and authorization. The main difference lies in their specific responsibilities, with associates assisting in the process and coordinators actively conducting reviews and approvals.
What are the most commonly searched types of Utilization Management jobs in Texas?
The most popular types of Utilization Management jobs in Texas are:
What cities in Texas are hiring for Utilization Management Associate jobs?
Cities in Texas with the most Utilization Management Associate job openings:
Health Plan Referral Specialist - HP Utilization Management
Irving, TX • On-site
CHRISTUS Health
• Outpatient Health Care • 1 - 5K employees1,001 - 5,000 employees
Other
Medical
Re-posted 24 days ago
CHRISTUS Health rating
6.7
Based on 538 frontline employees who took The Breakroom Quiz
Job description
Health Plan Referral Specialist - HP Utilization Management
US:TX:Irving | Health Plans | Full Time
Summary:
Processes all requests for referral authorizations and researches problem referral claims or requests for payment.
Responsibilities:
- Meets expectations of the applicable One CHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- Expedite the flow of authorization requests through the Managed Care System. Prepare requests for authorization of services by ensuring form completion, eligibility, verification, chart availability, benefits etc. Accurately enter referral information into the computer system with a thorough understanding of the correct system codes (type, status, procedure etc.)
- Facilitate documentation of authorizations into the computer system.
- Notify patients and providers of authorization decisions and maintains accurate tracking of services.
- Request and print various system report to perform daily tasks and to track referral based activity for management reporting purposes.
- Utilize tracking system to monitor the flow of referrals through the authorization process and to allow for measurement of turn around times and timely processing of referrals.
- Prepare requests for authorization of services by ensuring form completion, eligibility, verification, chart availability, benefits, etc.
- Notify all parties involved of authorization decisions to include patient, provider, requester, HMO, etc. Ensure appropriate actions have occurred such as scheduling of diagnostic appointments, requests for documentation/treatment plan etc.
- Distribute copies of referral to all appropriate sources (chart, provider, etc.) and accurately document activities associated with the referral in the medical file and computer system.
- Coordinate the initiation of specific home health services, DME services, diagnostics, etc., as directed by the nurse / physician for managed care plan members.
- Serve as a resource to staff and providers regarding managed care systems, HMO/PPO benefits, contracted providers, etc.
- Interface with HMO/PPO patients for direction through the referral process to increase an understanding of the authorization requirements mandated by the insurance plan.
- Promote and coordinate activities of payer agencies, groups or individuals to help provide answers and meet the needs of provider and/or patient.
- Assist in referral research for billing and collections process.
- Maintain contact with representatives of other organizations to exchange and update information on resources and services available.
Requirements:
Education/Skills
- High School diploma or equivalent required
- Associate's degree or higher in allied health professional field of study, preferred
- Working Knowledge of medical terminology and CPT background, preferred
- Good typing skills
- Basic knowledge of computers
- Excellent customer service skills
Experience
- Minimum of two (2) years in related working environment such as hospital, physician office, or managed care organization, preferred
Licenses, Registrations, or Certifications
- None required
Work Schedule:
5 Days - 8 Hours
Work Type:
Full Time
What CHRISTUS Health employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About CHRISTUS Health
Sourced by ZipRecruiter
CHRISTUS Health is a prominent name in the healthcare industry, with its headquarters situated in Irving, TX, USA. Established in 1999, the company has since been devoted to providing comprehensive care and extending the healing ministry of Jesus Christ. This not-for-profit health system primarily operates more than 600 healthcare services and programs, including long-term care facilities, health insurance products, community clinics, and outreach services, serving both urban and rural populations.
Industry
Outpatient health care
Company size
1,001 - 5,000 Employees
Headquarters location
Irving, TX, US
Year founded
1999