Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Enfermero(a) Graduado
San Juan, PR · On-site
Demonstrate knowledge and utilization of universal precautions in providing direct patient care. * Accurately administer medications per ordered note. * Document accurate count of controlled ...
Enfermero(a) Graduado
San Juan, PR · On-site
Demonstrate knowledge and utilization of universal precautions in providing direct patient care. * Accurately administer medications per ordered note. * Document accurate count of controlled ...
Demonstrate knowledge and utilization of universal precautions in providing direct patient care. * Accurately administer medications per ordered note. * Document accurate count of controlled ...
Demonstrate knowledge and utilization of universal precautions in providing direct patient care. * Accurately administer medications per ordered note. * Document accurate count of controlled ...
RN - Behavioral Health - Relocate to Michigan (Sign On Bonus)
San Juan, PR · On-site
$28 - $41/hr
Support quality improvement efforts and efficient resource utilization * Provide emotional, mental, physical, and spiritual support to patients across settings Required/Desired Qualifications:
Quick apply
RN - Behavioral Health - Relocate to Michigan (Sign On Bonus)
San Juan, PR · On-site
$28 - $41/hr
Support quality improvement efforts and efficient resource utilization * Provide emotional, mental, physical, and spiritual support to patients across settings Required/Desired Qualifications:
$46K - $119K/yr
... utilization. RN integrates outpatient nursing knowledge, skills, abilities, and judgment and is ... Review our benefits Eligibility for benefits depends on the type of position you hold and whether ...
$46K - $119K/yr
... utilization. RN integrates outpatient nursing knowledge, skills, abilities, and judgment and is ... Review our benefits Eligibility for benefits depends on the type of position you hold and whether ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System. * Ensures appropriate preparation of lab requisitions for Spectra or alternate lab. * Ensures ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System. * Ensures appropriate preparation of lab requisitions for Spectra or alternate lab. * Ensures ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System. * Ensures appropriate preparation of lab requisitions for Spectra or alternate lab. * Ensures ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System. * Ensures appropriate preparation of lab requisitions for Spectra or alternate lab. * Ensures ...
Registered Nurse
San Antonio, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Registered Nurse
San Antonio, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Registered Nurse
Arecibo, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Registered Nurse
Arecibo, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System. * Ensures appropriate preparation of lab requisitions for Spectra or alternate lab. * Ensures ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System. * Ensures appropriate preparation of lab requisitions for Spectra or alternate lab. * Ensures ...
Registered Nurse
Aguada, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Registered Nurse
Aguada, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System. * Ensures appropriate preparation of lab requisitions for Spectra or alternate lab. * Ensures ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System. * Ensures appropriate preparation of lab requisitions for Spectra or alternate lab. * Ensures ...
Registered Nurse
Adjuntas, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Registered Nurse
Adjuntas, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System. * Ensures appropriate preparation of lab requisitions for Spectra or alternate lab. * Ensures ...
Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System. * Ensures appropriate preparation of lab requisitions for Spectra or alternate lab. * Ensures ...
Registered Nurse
Aguirre, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Registered Nurse
Aguirre, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Registered Nurse
Aibonito, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Registered Nurse
Aibonito, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Registered Nurse
Aguadilla, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Registered Nurse
Aguadilla, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Registered Nurse
Arroyo, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Registered Nurse
Arroyo, PR · On-site
Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter. Additional ...
Utilization Review 1099 information
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 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 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?
| 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 Puerto Rico? For Utilization Review 1099 jobs in Puerto Rico, the most frequently searched job titles are:
What job categories do people searching Utilization Review 1099 jobs in Puerto Rico look for? The top searched job categories for Utilization Review 1099 jobs in Puerto Rico are:
- Full Time Cigna Utilization Review Nurse
- Optum Utilization Review Nurse
- Full Time Weekend Utilization Review
- Utilization Review
- Remote Physical Therapy Utilization Review
- Fulltime Cigna Utilization Review Nurse
- Cigna Utilization Review Remote
- Utilization Review Nurse Compact License
- Volunteer Aetna Utilization Review Nurse
Full-time
Posted 12 days ago
Job description
Overview
PURPOSE STATEMENT:
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
ResponsibilitiesESSENTIAL FUNCTIONS:
- Act as liaison between managed care organizations and the facility professional clinical staff.
- Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
- Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
- Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
- Conduct quality reviews for medical necessity and services provided.
- Facilitate peer review calls between facility and external organizations.
- Initiate and complete the formal appeal process for denied admissions or continued stay.
- Assist the admissions department with pre-certifications of care.
- Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
OTHER FUNCTIONS:
- Perform other functions and tasks as assigned.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- Required Education: High school diploma or equivalent.
- Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
- Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
- CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
- First aid may be required based on state or facility requirements.
ADDITIONAL REGULATORY REQUIREMENTS:
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.
Employment Type: FULL_TIME