The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to ... Maintains current knowledge of managed care requirements and accurately interprets these ...
The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to ... Maintains current knowledge of managed care requirements and accurately interprets these ...
Utilization Review Specialist
Tulsa, OK Ā· On-site
The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to ... Maintains current knowledge of managed care requirements and accurately interprets these ...
Utilization Review Specialist
Tulsa, OK Ā· On-site
The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to ... Maintains current knowledge of managed care requirements and accurately interprets these ...
UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. License:
UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. License:
UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. License:
UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. License:
Utilization Review And Management (UM) Component Program The utilization review and management (UM) component program ensures that external healthcare services provided across MedTrust/MedHealth ...
Utilization Review And Management (UM) Component Program The utilization review and management (UM) component program ensures that external healthcare services provided across MedTrust/MedHealth ...
The utilization review and management (UM) component program ensures that external healthcare services provided across MedTrust/MedHealth contracted facilities are medically necessary, clinically ...
Quick apply
The utilization review and management (UM) component program ensures that external healthcare services provided across MedTrust/MedHealth contracted facilities are medically necessary, clinically ...
Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support ...
Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support ...
This position will be responsible for conducting utilization review/medical management for all services including training/mentoring other team members and performing preliminary research on ...
This position will be responsible for conducting utilization review/medical management for all services including training/mentoring other team members and performing preliminary research on ...
This position will be responsible for conducting utilization review/medical management for all services including training/mentoring other team members and performing preliminary research on ...
Quick apply
This position will be responsible for conducting utilization review/medical management for all services including training/mentoring other team members and performing preliminary research on ...
This position will be responsible for conducting utilization review/medical management for all services including training/mentoring other team members and performing preliminary research on ...
This position will be responsible for conducting utilization review/medical management for all services including training/mentoring other team members and performing preliminary research on ...
RN Case Manager - Utilization Review Join our team as a day shift/variable, full time, RN Case Manager - Utilization Review, at INTEGRIS Baptist Medical Center, Oklahoma City, OK. Qualifications ...
New
RN Case Manager - Utilization Review Join our team as a day shift/variable, full time, RN Case Manager - Utilization Review, at INTEGRIS Baptist Medical Center, Oklahoma City, OK. Qualifications ...
New
Managed care, PBM, or health-plan preferred. Hospital and community pharmacists with strong ... Utilization Review Pharmacist opening.
New
Managed care, PBM, or health-plan preferred. Hospital and community pharmacists with strong ... Utilization Review Pharmacist opening.
New
Managed care, PBM, or health-plan preferred. Hospital and community pharmacists with strong ... Utilization Review Pharmacist opening.
New
Managed care, PBM, or health-plan preferred. Hospital and community pharmacists with strong ... Utilization Review Pharmacist opening.
New
Utilization Review Clinician - Behavioral Health
Oklahoma City, OK Ā· On-site
$27.02 - $48.55/hr
Behavioral Health Utilization Management Training Schedule: Mondayâ??Friday, 8:00 a.m.â??5:00 p.m ... Performs a clinical review and assesses care related to mental health and substance abuse. Monitors ...
Utilization Review Clinician - Behavioral Health
Oklahoma City, OK Ā· On-site
$27.02 - $48.55/hr
Behavioral Health Utilization Management Training Schedule: Mondayâ??Friday, 8:00 a.m.â??5:00 p.m ... Performs a clinical review and assesses care related to mental health and substance abuse. Monitors ...
Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high ...
Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high ...
Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high ...
Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high ...
Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high ...
Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high ...
Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high ...
Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high ...
Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high ...
Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high ...
Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...
Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...
Utilization Review Manager information
See Oklahoma salary details
$36K - $46.8K
9% of jobs
$54.8K is the 25th percentile. Wages below this are outliers.
$46.8K - $57.6K
22% of jobs
$57.6K - $68.4K
11% of jobs
The median wage is $75K / yr.
$68.4K - $79.2K
14% of jobs
$79.2K - $89.9K
12% of jobs
$96.7K is the 75th percentile. Wages above this are outliers.
$89.9K - $100.7K
13% of jobs
$100.7K - $111.5K
13% of jobs
$111.5K - $122.3K
5% of jobs
$122.3K - $133.1K
2% of jobs
$133.1K - $143.9K
0% of jobs
$143.9K - $154.7K
0% of jobs
$36K
$84K
$154.7K
How much do utilization review manager jobs pay per year?
Is utilization review a stressful job?
What are some common challenges faced by utilization review managers in balancing patient care and cost efficiency?
What are the key skills and qualifications needed to thrive as a utilization review manager?
What is the difference between Utilization Review Manager vs Utilization Review Coordinator?
| Aspect | Utilization Review Manager | Utilization Review Coordinator |
|---|---|---|
| Certifications | Typically requires certifications like CCM or ACU | May require similar certifications but often less advanced |
| Work Environment | Supervises review teams, manages processes in healthcare or insurance settings | Performs case reviews, supports the review process under supervision |
| Employer & Industry | Hospitals, insurance companies, healthcare organizations | Insurance companies, healthcare providers, third-party administrators |
The Utilization Review Manager oversees review teams and manages utilization review processes, focusing on policy compliance and efficiency. The Utilization Review Coordinator supports the review process by conducting case assessments and assisting managers. While both roles require similar certifications and work in related environments, the manager holds a supervisory position with broader responsibilities.
What does a utilization review manager do?
- Weekend Physician Advisor Utilization Review
- Therapist Utilization Review Remote
- Part Time Utilization Review Nurse
- Flex Schedule Remote Utilization Review Nurse
- Remote Utilization Management Nurse
- Remote Utilization Review Rn
- Night Utilization Review Nurse
- Utilization Review Nurse
- No Experience Utilization Review Nurse
- Utilization Management Nurse
- Lpn Utilization Review
- Remote Optum Utilization Review
- Cigna Utilization Review Remote
- Part Time Utilization Review
- Remote Weekend Utilization Review
- Manager Aetna Utilization Review
- Insurance Utilization Review
- Temporary Aetna Utilization Review Nurse
- Remote Dental Utilization Review
- Behavioral Utilization Review

Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 5 days ago
Job description
Parkside provides professional purpose, hope, and healing. As a member of our staff, you will be part of a mission-driven team, dedicated to changing lives and changing communities, one patient at a time.Ā
Parkside Psychiatric Hospital & Outpatient Clinic is a comprehensive mental healthcare system providing acute inpatient care, residential treatment, and outpatient therapy. With a focus on societyās most vulnerable population, Parkside provides world-class mental health services for youth and adults. For over 65 years, Parksideās physicians, therapists, and staff have providedĀ state of the art, patient-centered care that propels families from hopeful to hope-filled. As a center of excellence, we cultivate talent and provide professionalĀ purpose. Together weĀ facilitateĀ healing, one patient at a time.Ā
We are looking for a Full Time Utilization Review Specialist! The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private insurance. Coordinates with clinicians, business office and medical records to achieve above goals.
Responsibilities:
⢠Prepares authorization paperwork, processes requests for authorizations, and reviews requests for accuracy.
⢠Communicates with clinicians regarding discharge issues relevant to patientās pay source. Tracks due dates for authorization reviews and alerts clinicians.
⢠Communicates with clinicians regarding admissions and discharges to various units.
⢠Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage. Maintains current knowledge of managed care requirements and accurately interprets these requirements to increase authorizations.
⢠Coordinates/completes the appeal process for authorization denials
⢠Performs audits of clinical services to ensure compliance with standards of third party pay sources and agency policies.
⢠Tracks unauthorized services and possible recoupment issues. Looks for possible corrections, trends.
 ⢠Maintains a good working relationship within the department and with other departments.
⢠Documentation meets current standards and policies.
 ⢠Maintains fit for duty. Acts in a professional manner and follows all Parkside policies and procedures.
⢠Orients new staff members to the unit
⢠Demonstrates the ability to be organized and flexible, acts appropriately in stressful/emergency situations. Able to provide Handle with Care when needed
⢠Performs other duties as assigned
- Bachelorās degree in related field from an accredited university required. Experience in lieu of Degree will be considered.
- 2yrs minimal experience in health care, utilization review and business setting
Benefits include:
- Medical, Dental, and Vision
- Generous Paid Time Off and Holidays
- 401K and match startĀ immediately, and includes a generous match
- Company Paid Life Insurance and Disability and more!
We are an Equal Opportunity Employer!Ā