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Utilization Review 1099 Jobs in Delaware (NOW HIRING)

UHS

PRN Utilization Management Coordinator

Dover, DE · On-site

Conduct admission reviews working with Assessment and Referral Services to stay abreast of ... Perform internal utilization reviews as indicated. * Identify, document, and report any and all ...

UHS

Lead UR Coordinator

Dover, DE · On-site

Perform internal utilization reviews as indicated. * Identify, document, and report any and all instances of adult or child abuse and neglect to the appropriate parties including a member of ...

UHS

Lead UR Coordinator

Dover, DE · On-site

Maintain and update logs of review and maintain other appropriate records of the Utilization Review department. * Communicate pertinent third party payors issues to doctor and treatment team.

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Utilization Review 1099 information

What are the key skills and qualifications needed to thrive as a Utilization Review 1099, and why are they important?

To thrive as a Utilization Review 1099 professional, you need a strong clinical background (often as a registered nurse or similar), experience with medical necessity criteria, and familiarity with insurance guidelines. Proficiency with utilization management software, electronic health records (EHRs), and knowledge of regulatory requirements are typically required, along with URAC or CCM certification being advantageous. Excellent analytical thinking, attention to detail, and effective communication skills are essential for collaborating with healthcare providers and payers. These skills ensure accurate, efficient review of patient care for coverage decisions, compliance, and cost-effective healthcare delivery.

What are some typical challenges faced by Utilization Review professionals working as 1099 contractors, and how can they be managed?

Utilization Review professionals working as 1099 contractors often face challenges such as fluctuating caseloads, varying client requirements, and the need to stay current with changing regulations independently. Unlike full-time employees, contractors must also manage their own schedules, billing, and sometimes provide their own resources and training. To succeed, it's important to establish clear communication with clients, maintain up-to-date credentials, and leverage professional networks or continuing education resources to stay informed about industry changes.

What is a Utilization Review 1099 position?

A Utilization Review 1099 position refers to a healthcare professional, often a nurse or therapist, who works as an independent contractor (not a direct employee) to review medical cases for necessity and efficiency. The '1099' designation means they receive a Form 1099 for tax purposes and are responsible for their own taxes. Utilization Review specialists evaluate patient records to ensure treatments are appropriate and meet insurance or regulatory guidelines. These roles are often remote and offer flexible hours, but do not provide traditional employee benefits.

What is the difference between Utilization Review 1099 vs Utilization Review Nurse?

AspectUtilization Review 1099Utilization Review Nurse
CredentialsVaries; often self-employed or independent contractorsRegistered Nurse (RN) license required
Work EnvironmentRemote or freelance; contract basisHealthcare facilities, insurance companies, or clinics
Employer/Industry UsageFreelance or independent consulting in healthcareHospitals, insurance providers, healthcare organizations
Work FocusReviewing medical necessity for insurance claimsAssessing patient records, making clinical decisions

Utilization Review 1099 typically refers to independent contractors reviewing insurance claims, often working remotely. Utilization Review Nurse is a licensed RN performing clinical assessments within healthcare settings. While both roles involve utilization review, the 1099 role emphasizes independent contracting, whereas the nurse role requires clinical credentials and direct patient or clinical record involvement.

What are popular job titles related to Utilization Review 1099 jobs in Delaware? For Utilization Review 1099 jobs in Delaware, the most frequently searched job titles are:
What job categories do people searching Utilization Review 1099 jobs in Delaware look for? The top searched job categories for Utilization Review 1099 jobs in Delaware are:
What cities in Delaware are hiring for Utilization Review 1099 jobs? Cities in Delaware with the most Utilization Review 1099 job openings:
Utilization Review 1099 jobs near you

PRN Utilization Management Coordinator

Alan B. Miller Medical Center

Dover, DE

Per diem

Posted 20 days ago

Job description

Per Diem Utilization Management Coordinator

Dover Behavioral Health System is a 104-bed, acute care psychiatric hospital located in the beautiful Dover, Delaware area. Dover Behavioral Health System features individual units for adolescents and adults and offers inpatient acute care, partial hospitalization, and intensive outpatient programs. On average, over 10,000 patients receive care from our compassionate health care team each year at Dover Behavioral Health System. This opportunity offers working at a hospital known for its outstanding patient satisfaction, including ranking 6th for highest patient satisfaction in 2020 compared to over 200+ psychiatric hospitals. We attribute this success to our talented and dedicated staff. Dover Behavioral Health system is seeking qualified candidates for our Per Diem Utilization Management Coordinator position. In this role, you will proactively monitor utilization of continuum services and optimize reimbursement. Responsibilities will include:

  • Conduct admission reviews working with Assessment and Referral Services to stay abreast of admissions.
  • Conduct concurrent and extended stay reviews on appropriate day and/or specified time.
  • Prepare and submit appeals to third party payors, effectively coordinating collection of all pertinent data to support the hospital and patient's position.
  • Call/fax discharge information to insurance companies within 24 hours of discharge to ensure the facility is paid for the hospital stay.
  • Maintain and update logs of review and maintain other appropriate records of the Utilization Review department.
  • Communicate pertinent third party payors issues to doctor and treatment team.
  • Attend daily treatment team meetings to discuss acuity issues, third party payors needs and gather information for reviews.
  • Work independently in gathering information for reviews from the patient record, taking the initiative to seek information from members of the treatment team.
  • Understand and communicate insurance information to team members, including benefits and levels of care offered.
  • Perform internal utilization reviews as indicated.
  • Identify, document, and report any and all instances of adult or child abuse and neglect to the appropriate parties including a member of management, the police, and state agencies

Qualifications Minimum: MSW or MS in a recognized mental health field or a Registered Nursing License One (1) year experience in case management and/or hospital experience Preferred: One (1) year experience as a Utilization Management Coordinator at a long-term care facility

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