Utilization Review Assistant
Odessa, TX · On-site
Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred. Ability to communicate effectively and ...
Utilization Review Assistant
Odessa, TX · On-site
Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred. Ability to communicate effectively and ...
Utilization Review Assistant
Odessa, TX · On-site
Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred. Ability to communicate effectively and ...
Utilization Review Assistant
Odessa, TX · On-site
Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred. Ability to communicate effectively and ...
Utilization Review Assistant
Odessa, TX · On-site
Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred. Ability to communicate effectively and ...
Utilization Review Assistant
Odessa, TX · On-site
Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred. Ability to communicate effectively and ...
Experience with utilization management in behavioral and/or medical healthcare. Experience driving quality and timely discharge planning from residential facilities as deemed appropriate in review of ...
Experience with utilization management in behavioral and/or medical healthcare. Experience driving quality and timely discharge planning from residential facilities as deemed appropriate in review of ...
Experience with utilization management in behavioral and/or medical healthcare. Experience driving quality and timely discharge planning from residential facilities as deemed appropriate in review of ...
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Experience with utilization management in behavioral and/or medical healthcare. Experience driving quality and timely discharge planning from residential facilities as deemed appropriate in review of ...
Experience with utilization management in behavioral and/or medical healthcare. Experience driving quality and timely discharge planning from residential facilities as deemed appropriate in review of ...
Experience with utilization management in behavioral and/or medical healthcare. Experience driving quality and timely discharge planning from residential facilities as deemed appropriate in review of ...
Utilization Review Specialist
$70K - $100K/yr
Utilization review experience Additional Skills & Qualifications * Perform utilization review ... Collaborate with physicians, case management teams, and payers to support authorization and ...
Posted today
Utilization Review Specialist
$70K - $100K/yr
Utilization review experience Additional Skills & Qualifications * Perform utilization review ... Collaborate with physicians, case management teams, and payers to support authorization and ...
Posted today
Utilization Review Nurse
Big Spring, TX · On-site
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
Utilization Review Nurse
Big Spring, TX · On-site
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
Utilization Review Nurse
Dallas, TX · Remote
$35 - $45.94/hr
We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...
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Utilization Review Nurse
Dallas, TX · Remote
$35 - $45.94/hr
We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
Utilization Review Specialist
$70K - $100K/yr
Utilization review experience Additional Skills & Qualifications * Perform utilization review ... Collaborate with physicians, case management teams, and payers to support authorization and ...
Posted today
Utilization Review Specialist
$70K - $100K/yr
Utilization review experience Additional Skills & Qualifications * Perform utilization review ... Collaborate with physicians, case management teams, and payers to support authorization and ...
Posted today
Hours: 8:30-5:30, Monday - Friday At Houston Methodist, the Utilization Review Nurse (URN) position ... This position collaborates with case management in the development and implementation of the plan ...
Hours: 8:30-5:30, Monday - Friday At Houston Methodist, the Utilization Review Nurse (URN) position ... This position collaborates with case management in the development and implementation of the plan ...
Utilization Review Nurse
Plano, TX · Remote
This position is responsible for performing initial, concurrent review activities; discharge care ... Provides information regarding utilization management requirements and operational procedures to ...
Utilization Review Nurse
Plano, TX · Remote
This position is responsible for performing initial, concurrent review activities; discharge care ... Provides information regarding utilization management requirements and operational procedures to ...
Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge reviews for all patients based on: * InterQual ® , MCG, or payer-specific medical necessity criteria.
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Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge reviews for all patients based on: * InterQual ® , MCG, or payer-specific medical necessity criteria.
Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge reviews for all patients based on: * InterQual ® , MCG, or payer-specific medical necessity criteria.
Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge reviews for all patients based on: * InterQual ® , MCG, or payer-specific medical necessity criteria.
Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge reviews for all patients based on: * InterQual ® , MCG, or payer-specific medical necessity criteria.
Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge reviews for all patients based on: * InterQual ® , MCG, or payer-specific medical necessity criteria.
The Utilization Review RN is responsible for ensuring that all behavioral health patients receive ... Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge ...
The Utilization Review RN is responsible for ensuring that all behavioral health patients receive ... Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge ...
Overview Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer ...
Overview Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer ...
Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer review. This ...
Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer review. This ...
Utilization Review RN
Houston, TX · On-site
Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... Every day, you will meticulously review medical records, authorize services, and prepare cases for ...
Utilization Review RN
Houston, TX · On-site
Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... Every day, you will meticulously review medical records, authorize services, and prepare cases for ...
Utilization Review Management information
What are the job titles for utilization review management?
Job titles in utilization review management include Utilization Review Nurse, Utilization Review Coordinator, Utilization Review Nurse Case Manager, and Utilization Review Supervisor. These roles typically involve assessing medical necessity, reviewing patient records, and ensuring compliance with healthcare policies, often requiring certification such as the Certified Professional in Healthcare Quality (CPHQ).
What is the difference between Utilization Review Management vs Utilization Review Nurse?
| Aspect | Utilization Review Management | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a healthcare management or related certification, sometimes a nursing background | Registered Nurse (RN) license, often with additional utilization review certification |
| Work Environment | Office-based, administrative setting, collaborating with healthcare providers and insurance companies | Clinical setting, reviewing patient charts, and making utilization decisions |
| Employer & Industry | Health insurance companies, managed care organizations, healthcare administrators | Hospitals, insurance companies, healthcare facilities |
Utilization Review Management professionals focus on overseeing review processes, policy compliance, and administrative tasks, while Utilization Review Nurses conduct clinical assessments to determine appropriate care. Both roles are essential in healthcare utilization management but differ in responsibilities and work environment.
What are some common challenges faced by professionals in utilization review management, and how can they be addressed?
Professionals in Utilization Review Management often encounter challenges such as balancing regulatory compliance with patient advocacy and managing high caseloads under tight deadlines. Navigating complex insurance policies and ensuring timely communication between healthcare providers and payers can be demanding. Staying organized, leveraging technology for workflow management, and participating in ongoing training can help address these challenges. Additionally, strong collaboration with interdisciplinary teams ensures more effective and efficient utilization review processes.
What is utilization review management?
Utilization Review Management is a process used in healthcare to evaluate the necessity, appropriateness, and efficiency of medical services, procedures, and facilities. Its primary goal is to ensure that patients receive appropriate care while preventing unnecessary or duplicative services. Utilization Review Management helps healthcare providers and insurance companies manage costs, maintain high-quality care, and comply with regulations. Professionals in this field often review patient records, coordinate with clinicians, and make recommendations about coverage or care plans.
What are the key skills and qualifications needed to thrive in utilization review management?
To thrive in Utilization Review Management, you need a solid background in healthcare, strong analytical skills, and often a clinical degree such as RN or LPN, with certification in utilization review or case management being highly beneficial. Familiarity with medical coding systems (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required. Excellent communication, critical thinking, and negotiation skills help you collaborate with providers and payers while advocating for patient care. These competencies are vital for ensuring appropriate resource use, regulatory compliance, and optimal patient outcomes.
What cities in Texas are hiring for Utilization Review Management jobs? Cities in Texas with the most Utilization Review Management job openings:
Part-time
Re-posted 25 days ago
Medical Center Health System rating
8.4
Based on 33 frontline employees who took The Breakroom Quiz
23rd of 887 rated healthcare providers
Job description
Position Summary:
Assists UM Department with utilization review processes, including the collection and analysis of various computer-based data related to Utilization Review, Care Coordination, and Commercial Insurance.
Qualifications:
A. Education:
Must have a high school diploma or equivalent.
B. Training and Experience:
Must have a minimum of one-year work experience in an acute care medical facility.
C. Job Knowledge:
Familiar with medical terminology, utilization review, community resource a plus. Basic computer skills required. Be able to communicate effectively verbally and in writing.
Unusual Physical Demands and Working Conditions:
Should be familiar with healthcare operations. Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred.
Ability to communicate effectively and professionally, both verbally and in writing.
Assists UM Department with utilization review processes, including the collection and analysis of various computer-based data related to Utilization Review, Care Coordination, and Commercial Insurance.
Qualifications:
A. Education:
Must have a high school diploma or equivalent.
B. Training and Experience:
Must have a minimum of one-year work experience in an acute care medical facility.
C. Job Knowledge:
Familiar with medical terminology, utilization review, community resource a plus. Basic computer skills required. Be able to communicate effectively verbally and in writing.
Unusual Physical Demands and Working Conditions:
Should be familiar with healthcare operations. Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred.
Ability to communicate effectively and professionally, both verbally and in writing.
What Medical Center Health System employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Medical Center Health System
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Odessa, TX, US
Year founded
1949