Canton, MA · On-site
$55 - $60/hr
Evaluate requests for outpatient procedures, surgeries, imaging, therapies, specialty medications, and other healthcare services. * Ensure all utilization review activities meet regulatory turnaround ...
Canton, MA · On-site
$55 - $60/hr
Evaluate requests for outpatient procedures, surgeries, imaging, therapies, specialty medications, and other healthcare services. * Ensure all utilization review activities meet regulatory turnaround ...
The Utilization Review Coordinator opportunity is a key member of the Lighthouse Case Management ... Must be license-eligible or licensed in Georgia. (LAPC, LPC, LMSW, LCSW, LMFT, LMHC) * Must have 2 ...
The Utilization Review Coordinator opportunity is a key member of the Lighthouse Case Management ... Must be license-eligible or licensed in Georgia. (LAPC, LPC, LMSW, LCSW, LMFT, LMHC) * Must have 2 ...
Augusta, GA · On-site
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ... LMHC, LMFT, LAPC, LPC, LMSW, LCSW, LPN or RN preferred EEO Statement: All UHS subsidiaries are ...
Augusta, GA · On-site
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ... LMHC, LMFT, LAPC, LPC, LMSW, LCSW, LPN or RN preferred EEO Statement: All UHS subsidiaries are ...
The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced ... Collaborate with clinicians, therapists, case managers, and medical staff to gather accurate and up ...
The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced ... Collaborate with clinicians, therapists, case managers, and medical staff to gather accurate and up ...
Conduct utilization review activities to assess medical necessity, appropriateness of therapy, and compliance with payer policies, clinical guidelines, and formulary requirements. * Initiate, prepare ...
Quick apply
Conduct utilization review activities to assess medical necessity, appropriateness of therapy, and compliance with payer policies, clinical guidelines, and formulary requirements. * Initiate, prepare ...
Conduct utilization review activities to assess medical necessity, appropriateness of therapy, and compliance with payer policies, clinical guidelines, and formulary requirements. * Initiate, prepare ...
Conduct utilization review activities to assess medical necessity, appropriateness of therapy, and compliance with payer policies, clinical guidelines, and formulary requirements. * Initiate, prepare ...
The Utilization Review Coordinator opportunity is a key member of the Lighthouse Case Management ... Must be license-eligible or licensed in Georgia. (LAPC, LPC, LMSW, LCSW, LMFT, LMHC) * Must have 2 ...
The Utilization Review Coordinator opportunity is a key member of the Lighthouse Case Management ... Must be license-eligible or licensed in Georgia. (LAPC, LPC, LMSW, LCSW, LMFT, LMHC) * Must have 2 ...
Mountain View Hospital is looking for a Utilization Review Coordinator to join our team! JOB ... physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a ...
Mountain View Hospital is looking for a Utilization Review Coordinator to join our team! JOB ... physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a ...
Tulsa, OK · On-site
For over 65 years, Parkside's physicians, therapists, and staff have provided ... The Utilization Review Specialist assesses, plans, implements and evaluates the internal processes ...
Tulsa, OK · On-site
For over 65 years, Parkside's physicians, therapists, and staff have provided ... The Utilization Review Specialist assesses, plans, implements and evaluates the internal processes ...
What you will be doing? The Utilization Review (UR) Specialist is a critical member of the ... Collaborate with clinicians, therapists, case managers, and medical staff to gather accurate and up ...
Quick apply
What you will be doing? The Utilization Review (UR) Specialist is a critical member of the ... Collaborate with clinicians, therapists, case managers, and medical staff to gather accurate and up ...
The Utilization Review Coordinator opportunity is a key member of the Lighthouse Case Management ... Must be license-eligible or licensed in Georgia. (LAPC, LPC, LMSW, LCSW, LMFT, LMHC) * Must have 2 ...
The Utilization Review Coordinator opportunity is a key member of the Lighthouse Case Management ... Must be license-eligible or licensed in Georgia. (LAPC, LPC, LMSW, LCSW, LMFT, LMHC) * Must have 2 ...
Description The Utilization Review Specialist coordinates insurance authorizations for individual therapy and IOP services, ensuring clients receive appropriate and timely care. This role works ...
Description The Utilization Review Specialist coordinates insurance authorizations for individual therapy and IOP services, ensuring clients receive appropriate and timely care. This role works ...
Indianapolis, IN · On-site
$60 - $80/hr
Conduct utilization review activities to assess medical necessity, appropriateness of therapy, and compliance with payer policies, clinical guidelines, and formulary requirements. * Initiate, prepare ...
Indianapolis, IN · On-site
$60 - $80/hr
Conduct utilization review activities to assess medical necessity, appropriateness of therapy, and compliance with payer policies, clinical guidelines, and formulary requirements. * Initiate, prepare ...
Conduct utilization review activities to assess medical necessity, appropriateness of therapy, and compliance with payer policies, clinical guidelines, and formulary requirements. * Initiate, prepare ...
Conduct utilization review activities to assess medical necessity, appropriateness of therapy, and compliance with payer policies, clinical guidelines, and formulary requirements. * Initiate, prepare ...
Aurora, CO · On-site
$64K/yr
Reporting to the Director of Utilization Review with a dotted-line relationship to the Director of ... Provide real-time coaching and written feedback to clinicians, therapists, and medical providers on ...
Aurora, CO · On-site
$64K/yr
Reporting to the Director of Utilization Review with a dotted-line relationship to the Director of ... Provide real-time coaching and written feedback to clinicians, therapists, and medical providers on ...
As the Director of Utilization Review , you will play a critical leadership role in ensuring the ... Collaborates with physicians, therapist and nursing staff to provide optimal review based on ...
As the Director of Utilization Review , you will play a critical leadership role in ensuring the ... Collaborates with physicians, therapist and nursing staff to provide optimal review based on ...
Augusta, GA · On-site
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ... LMHC, LMFT, LAPC, LPC, LMSW, LCSW, LPN or RN preferred EEO Statement: All UHS subsidiaries are ...
Augusta, GA · On-site
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ... LMHC, LMFT, LAPC, LPC, LMSW, LCSW, LPN or RN preferred EEO Statement: All UHS subsidiaries are ...
Decatur, GA · On-site
The Utilization Review Specialist coordinates insurance authorizations for individual therapy and IOP services, ensuring clients receive appropriate and timely care. This role works closely with ...
Decatur, GA · On-site
The Utilization Review Specialist coordinates insurance authorizations for individual therapy and IOP services, ensuring clients receive appropriate and timely care. This role works closely with ...
Aurora, CO · On-site
$64K/yr
Reporting to the Director of Utilization Review with a dotted-line relationship to the Director of ... Provide real-time coaching and written feedback to clinicians, therapists, and medical providers on ...
Aurora, CO · On-site
$64K/yr
Reporting to the Director of Utilization Review with a dotted-line relationship to the Director of ... Provide real-time coaching and written feedback to clinicians, therapists, and medical providers on ...
Be Seen First
Fontana, CA · On-site
$69 - $70/hr
Review occupational therapy recommendations, treatment plans, and proposed accommodations or modifications. * Evaluate and confirm that recommended modifications are clinically appropriate and ...
Quick apply
Be Seen First
Fontana, CA · On-site
$69 - $70/hr
Review occupational therapy recommendations, treatment plans, and proposed accommodations or modifications. * Evaluate and confirm that recommended modifications are clinically appropriate and ...
$23.32 - $27.29
2% of jobs
$27.29 - $31.27
3% of jobs
$31.27 - $35.25
8% of jobs
$38.81 is the 25th percentile. Wages below this are outliers.
$35.25 - $39.23
13% of jobs
$39.23 - $43.20
18% of jobs
The median wage is $44.42 / hr.
$43.20 - $47.18
19% of jobs
$50.16 is the 75th percentile. Wages above this are outliers.
$47.18 - $51.16
16% of jobs
$51.16 - $55.14
11% of jobs
$55.14 - $59.11
5% of jobs
$59.11 - $63.09
3% of jobs
$63.09 - $67.07
2% of jobs
$23
$45
$67
Cities with the most Utilization Review Occupational Therapist job openings:
States with the most job openings for Utilization Review Occupational Therapist jobs include:
For Utilization Review Occupational Therapist jobs, the most frequently searched job titles are:
Canton, MA • On-site
$55 - $60/hr
Other
Re-posted 2 days ago
$55-$60 per hour
Canton, MA
Contract
Duration: 6 Month Contract (Possibility of Extension)
Position Overview
We are seeking an experienced Utilization Management (UM) Registered Nurse to support outpatient utilization review and prior authorization activities for a leading healthcare organization. The ideal candidate will have a strong background in managed care, utilization management, medical necessity review, prior authorization, and outpatient clinical review.
This role is responsible for reviewing medical records, evaluating the medical necessity of requested services using established clinical guidelines, collaborating with physicians and healthcare providers, and ensuring timely authorization decisions while maintaining compliance with regulatory standards.
Key Responsibilities
Perform outpatient utilization management (UM) and medical necessity reviews for prior authorization and precertification requests.
Review clinical documentation and determine benefit eligibility using evidence-based clinical guidelines and health plan policies.
Evaluate requests for outpatient procedures, surgeries, imaging, therapies, specialty medications, and other healthcare services.
Ensure all utilization review activities meet regulatory turnaround time requirements.
Collaborate with Medical Directors for complex cases, denial recommendations, and clinical escalations.
Communicate authorization decisions with physicians, provider offices, hospitals, and healthcare facilities.
Participate in appeal reviews and provide clinical recommendations when appropriate.
Maintain accurate documentation within utilization management systems.
Monitor cases for quality, compliance, and adherence to organizational policies.
Identify opportunities for process improvement and contribute to quality initiatives.
Serve as a clinical resource for internal teams regarding utilization management guidelines and medical necessity criteria.
Required Qualifications
Active, unrestricted Registered Nurse (RN) license.
Associate Degree in Nursing (ADN) required.
Minimum 5 years of RN clinical experience.
Minimum 3-5 years of Utilization Management (UM), Case Management, Prior Authorization, or Medical Management experience.
Previous Managed Care, Health Plan, Medicare, Medicaid, or Commercial Insurance experience.
Strong knowledge of:
Utilization Management (UM)
Medical Necessity Review
Prior Authorization
Precertification
InterQual and/or MCG Guidelines
Experience reviewing outpatient clinical services.
Excellent clinical assessment and critical thinking skills.
Strong communication skills with providers and interdisciplinary teams.
Ability to work independently in a remote environment.
Comfortable using multiple systems while managing a high-volume workload.
Preferred Qualifications
BSN preferred.
Experience with outpatient utilization management.
Experience using InterQual and/or MCG clinical criteria.
Experience with Medicare Advantage or Commercial Health Plans.
Previous experience with appeals, grievances, or denial reviews.
Knowledge of NCQA, CMS, and utilization management regulatory requirements.
Note:
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
AI Statement: By applying, you acknowledge that AI-assisted tools may be used during hiring.
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US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.
It services
1,001 - 5,000 Employees
Jersey City, NJ, US
2000
