... for a Utilization Review Coordinator to coordinate patients' services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with ...
... for a Utilization Review Coordinator to coordinate patients' services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with ...
Reviewing patient admission clinical information using clinical criteria and guidelines available ... Maintaining knowledge regarding current regulations (PRO, TJC, AHA, etc.) which impact utilization ...
Reviewing patient admission clinical information using clinical criteria and guidelines available ... Maintaining knowledge regarding current regulations (PRO, TJC, AHA, etc.) which impact utilization ...
Reviewing patient admission clinical information using clinical criteria and guidelines available ... Maintaining knowledge regarding current regulations (PRO, TJC, AHA, etc.) which impact utilization ...
Reviewing patient admission clinical information using clinical criteria and guidelines available ... Maintaining knowledge regarding current regulations (PRO, TJC, AHA, etc.) which impact utilization ...
Reviewing patient admission clinical information using clinical criteria and guidelines available ... Maintaining knowledge regarding current regulations (PRO, TJC, AHA, etc.) which impact utilization ...
Reviewing patient admission clinical information using clinical criteria and guidelines available ... Maintaining knowledge regarding current regulations (PRO, TJC, AHA, etc.) which impact utilization ...
Utilization Management Representative I Utilization Management Representative I Location : This ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Representative I Utilization Management Representative I Location : This ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
By performing review of services prospectively, retrospectively, and throughout the episode of care ... utilization review, and medical necessity - Act and perform within the scope of professional ...
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By performing review of services prospectively, retrospectively, and throughout the episode of care ... utilization review, and medical necessity - Act and perform within the scope of professional ...
W/Alt UM Nurse (BHS)
Granger, IN · On-site
Critical utilization management functions during the admission phase include admission review for medical necessity and appropriate patient status using standardized inpatient utilization criteria.
W/Alt UM Nurse (BHS)
Granger, IN · On-site
Critical utilization management functions during the admission phase include admission review for medical necessity and appropriate patient status using standardized inpatient utilization criteria.
Critical utilization management functions during the admission phase include admission review for medical necessity and appropriate patient status using standardized inpatient utilization criteria.
Critical utilization management functions during the admission phase include admission review for medical necessity and appropriate patient status using standardized inpatient utilization criteria.
UR Coordinator (PRN)
Kouts, IN · On-site
Experience in patient assessment, family motiviation, treatment planning and communication with external review organizations or comparable entities. • RN, LSW, LCSW license or equivalent. EEO ...
UR Coordinator (PRN)
Kouts, IN · On-site
Experience in patient assessment, family motiviation, treatment planning and communication with external review organizations or comparable entities. • RN, LSW, LCSW license or equivalent. EEO ...
RN Case Manager
Hammond, IN · On-site
The RN Case manager provides education to physicians and other members of the team on the issues related to utilization review including appropriateness of admission, level of care and external ...
RN Case Manager
Hammond, IN · On-site
The RN Case manager provides education to physicians and other members of the team on the issues related to utilization review including appropriateness of admission, level of care and external ...
Registered Nurse (RN)
Salem, IN · On-site
Participates in quality improvement and utilization review activities. * Participates in the orientation and training of new staff. * Participates in continuing education to continually improve ...
Registered Nurse (RN)
Salem, IN · On-site
Participates in quality improvement and utilization review activities. * Participates in the orientation and training of new staff. * Participates in continuing education to continually improve ...
Participates in quality improvement and utilization review activities. * Participates in the orientation and training of new staff. * Participates in continuing education to continually improve ...
Participates in quality improvement and utilization review activities. * Participates in the orientation and training of new staff. * Participates in continuing education to continually improve ...
... utilization review and management and discharge planning. Has accountability for the care, coordination, and discharge planning of inpatient and observation services. Exceptional Skills and ...
... utilization review and management and discharge planning. Has accountability for the care, coordination, and discharge planning of inpatient and observation services. Exceptional Skills and ...
... utilization review and management and discharge planning. Has accountability for the care, coordination, and discharge planning of inpatient and observation services. Exceptional Skills and ...
... utilization review and management and discharge planning. Has accountability for the care, coordination, and discharge planning of inpatient and observation services. Exceptional Skills and ...
... utilization review and management and discharge planning. Has accountability for the care, coordination, and discharge planning of inpatient and observation services. Exceptional Skills and ...
... utilization review and management and discharge planning. Has accountability for the care, coordination, and discharge planning of inpatient and observation services. Exceptional Skills and ...
... utilization review and management and discharge planning. Has accountability for the care, coordination, and discharge planning of inpatient and observation services. Exceptional Skills and ...
New
... utilization review and management and discharge planning. Has accountability for the care, coordination, and discharge planning of inpatient and observation services. Exceptional Skills and ...
New
... utilization review and management and discharge planning. Has accountability for the care, coordination, and discharge planning of inpatient and observation services. Exceptional Skills and ...
New
... utilization review and management and discharge planning. Has accountability for the care, coordination, and discharge planning of inpatient and observation services. Exceptional Skills and ...
New
Secondary Review Nurse - Indiana
Indianapolis, IN · Remote
$29 - $52/hr
The Secondary Review Nurse plays a critical role in evaluating clinical requests for Home and ... Monitor utilization patterns and identify opportunities for improved care coordination and cost ...
Secondary Review Nurse - Indiana
Indianapolis, IN · Remote
$29 - $52/hr
The Secondary Review Nurse plays a critical role in evaluating clinical requests for Home and ... Monitor utilization patterns and identify opportunities for improved care coordination and cost ...
Utilization Review 1099 information
What is a utilization review 1099?
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 are the key skills and qualifications needed to thrive as a utilization review 1099?
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 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 the difference between Utilization Review 1099 vs Utilization Review Nurse?
| Aspect | Utilization Review 1099 | Utilization Review Nurse |
|---|---|---|
| Credentials | Varies; often self-employed or independent contractors | Registered Nurse (RN) license required |
| Work Environment | Remote or freelance; contract basis | Healthcare facilities, insurance companies, or clinics |
| Employer/Industry Usage | Freelance or independent consulting in healthcare | Hospitals, insurance providers, healthcare organizations |
| Work Focus | Reviewing medical necessity for insurance claims | Assessing 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 Indiana?
For Utilization Review 1099 jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Utilization Review 1099 jobs in Indiana look for?
The top searched job categories for Utilization Review 1099 jobs in Indiana are:
- Discharge Planner Utilization Review
- Remote Hca Utilization Review
- Insurance Utilization Review
- Behavioral Utilization Review
- Optum Utilization Review
- Lpn Utilization Review Nurse
- Utilization Review Intake Coordinator
- Authorization Utilization Review Bcba
- Full Time Navihealth Utilization Review
- Flex Schedule Utilization Review
What cities in Indiana are hiring for Utilization Review 1099 jobs?
Cities in Indiana with the most Utilization Review 1099 job openings:
Utilization Review Coordinator - $5,000 Sign-On Bonus
Indianapolis, IN • On-site
Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 12 days ago
Job description
About Us
Healing Body and Mind.
NeuroPsychiatric Hospitals is a national leader in behavioral healthcare, specializing in patients with acute psychiatric and complex medical needs. Our hospitals use an interdisciplinary, multi-specialty approach that delivers high-quality, patient-centered care when it's needed most.
With locations in Indiana, Michigan, Texas, and Arizona, we're expanding access to our unique model of care across the United States. Join us and be part of a team dedicated to making a lasting difference in the lives of patients and families every day
Overview
NeuroPsychiatric Hospitals of Indianapolis is looking for a Utilization Review Coordinator to coordinate patients' services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with multidisciplinary teams.
Benefits of joining NPH
Responsibilities
Qualifications
Education: Bachelor's in Behavioral Health, Social Work, Counseling, Nursing or Psychology required. Master's degree preferred.
Experience: Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 years of case management experience, including discharge planning in a hospital setting required.
Licensure: Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred. Basic Life Support (BLS) and Handle with Care (HWC) obtained during orientation, if applicable.
Skills: Must have strong knowledge of medications and demonstrate exceptional time management, data entry, and communication skills. Must be detail oriented.#INDEEDLOW
Healing Body and Mind.
NeuroPsychiatric Hospitals is a national leader in behavioral healthcare, specializing in patients with acute psychiatric and complex medical needs. Our hospitals use an interdisciplinary, multi-specialty approach that delivers high-quality, patient-centered care when it's needed most.
With locations in Indiana, Michigan, Texas, and Arizona, we're expanding access to our unique model of care across the United States. Join us and be part of a team dedicated to making a lasting difference in the lives of patients and families every day
Overview
NeuroPsychiatric Hospitals of Indianapolis is looking for a Utilization Review Coordinator to coordinate patients' services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with multidisciplinary teams.
Benefits of joining NPH
- Competitive pay rates
- Medical, Dental, and Vision Insurance
- NPH 401(k) plan with up to 4% Company match
- Employee Assistance Program (EAP) Programs
- Generous PTO and Time Off Policy
- Special tuition offers through Capella University
- Work/life balance with great professional growth opportunities
- Employee Discounts through LifeMart
Responsibilities
- Filing documents as needed.
- Initial Precertification with payors.
- Concurrent Clinical review with payors.
- Document in the electronic system daily in real time.
- Admission audit.
- Ensures that CON's/RON's and CMS certifications are completed by provider.
- Consistently demonstrates professionalism with all internal and external customers as evidenced by positive customer and peer Communicates effectively with all staff and patients as evidenced by the establishment and maintenance of productive working relationships.
- Maintains knowledge of current trends and developments in the field by reading appropriate books; journals and other literature and attending related seminars or conferences.
- Maintains a professional approach with Assures protection and privacy of health information as attained through written, electronic or oral disclosures.
- Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
- Seeks guidance and remains knowledgeable of, and complies with, all applicable federal and state laws, as well as hospital polices that apply.
- Complies with hospital expectations regarding ethical behavior and standards of conduct.
- Complies with federal and hospital requirements in the areas of protected health information and patient information.
- Reconsiderations, assists with appeals as needed, arrange peer to peer level reviews, and report the outcomes to the VP of Care Management and Team.
- Provides education to nursing staff. ;eadership team, and providers regarding documentation.
- Actively works with the business office regarding resolution of appeals/denials and retrospective reviews.
Qualifications
Education: Bachelor's in Behavioral Health, Social Work, Counseling, Nursing or Psychology required. Master's degree preferred.
Experience: Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 years of case management experience, including discharge planning in a hospital setting required.
Licensure: Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred. Basic Life Support (BLS) and Handle with Care (HWC) obtained during orientation, if applicable.
Skills: Must have strong knowledge of medications and demonstrate exceptional time management, data entry, and communication skills. Must be detail oriented.#INDEEDLOW