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Utilization Review Physician Assistant Jobs in Puerto Rico

... and utilization of resources to support the improvement of customer service metrics.Essential ... Assist in the development and implementation of procedures and techniques which will improve the ...

Assistance in the development of STAR-reviewed education plans covering a variety of topics ... Support physician peer-to-peer engagement opportunities about the Care Specialist program by ...

Certified Pharmacy Technician

Caguas, PR · On-site

$17.50 - $21.50/hr

... assist in the practice of pharmacy, in accordance with state, federal, and company policy. Reviews ... to physicians. * Processes (corrects and resubmits) manual claims for third party program ...

Sales Associate - Soma

San Juan, PR · On-site

$9 - $12.25/hr

... communication through utilization of customer book. Operational Excellence • Supports ... When we do have an open position, we will review your application to determine if your ...

Sales Associate - Chico's

Ponce, PR · On-site

$13.75 - $18.50/hr

... utilization of customer book. Operational Excellence * Supports replenishment activities that keep ... When we do have an open position, we will review your application to determine if your ...

Sales Associate - Chico's

Ponce, PR · On-site

$13.75 - $18.50/hr

... communication through utilization of customer book. Operational Excellence • Supports ... When we do have an open position, we will review your application to determine if your ...

Sales Associate - Soma

San Juan, PR · On-site

$13.75 - $18.75/hr

... utilization of customer book. Operational Excellence * Supports replenishment activities that keep ... When we do have an open position, we will review your application to determine if your ...

Pharmacist - Registered

Bayamon, PR · On-site

$46.50 - $55.75/hr

Please click here to review the Costco Applicant Privacy Notice. The jobs listed are examples of ... Verifies prescriptions and refills with physicians by phone. Selects substitutions when necessary.

Pharmacist - Registered

San Juan, PR · On-site

$39.50 - $47.50/hr

Please click here to review the Costco Applicant Privacy Notice. The jobs listed are examples of ... Verifies prescriptions and refills with physicians by phone. Selects substitutions when necessary.

Pharmacist - Registered

Caguas, PR · On-site

$56.75 - $68.25/hr

Please click here to review the Costco Applicant Privacy Notice. The jobs listed are examples of ... Verifies prescriptions and refills with physicians by phone. Selects substitutions when necessary.

Pharmacist - Registered

Caguas, PR · On-site

$56.75 - $68.25/hr

Please click here to review the Costco Applicant Privacy Notice. The jobs listed are examples of ... Verifies prescriptions and refills with physicians by phone. Selects substitutions when necessary.

Pharmacist - Registered

Bayamon, PR · On-site

$49.25 - $59.25/hr

Please click here to review the Costco Applicant Privacy Notice. The jobs listed are examples of ... Verifies prescriptions and refills with physicians by phone. Selects substitutions when necessary.

PR · On-site

$14.75 - $17.75/hr

... assist in the practice of pharmacy, in accordance with state, federal, and company policy. Reviews ... to physicians. * Processes (corrects and resubmits) manual claims for third party program ...

Showing results 41-60

Utilization Review Physician Assistant information

What is a utilization review physician assistant?

A Utilization Review Physician Assistant (PA) is a healthcare professional who evaluates medical records and treatment plans to ensure that patient care is medically necessary, appropriate, and cost-effective. They review cases to determine if the care provided meets established guidelines and insurance requirements. Utilization Review PAs collaborate with physicians, nurses, insurance companies, and other healthcare providers to promote quality care while managing healthcare resources efficiently. Their work typically involves less direct patient care and more administrative responsibilities compared to traditional clinical PA roles.

What are the key skills and qualifications needed to thrive as a utilization review physician assistant?

To thrive as a Utilization Review Physician Assistant, you need a strong clinical background, current PA licensure, and in-depth knowledge of medical guidelines and insurance protocols. Familiarity with electronic medical records (EMRs), utilization management software, and relevant certification such as the Certified Professional in Utilization Review (CPUR) is often beneficial. Strong analytical thinking, attention to detail, and effective communication are crucial soft skills for evaluating cases and interacting with healthcare providers and payers. These competencies are essential to ensure appropriate care delivery, compliance with regulations, and cost-effective use of medical resources.

What are some of the main challenges utilization review physician assistants face when transitioning from direct patient care to a review-focused role?

One of the main challenges Utilization Review Physician Assistants encounter is adapting to a predominantly administrative and analytical environment, as opposed to the hands-on patient care they may be accustomed to. The role requires interpreting clinical documentation, applying payer criteria, and making objective determinations about medical necessity, often with limited patient interaction. Additionally, there can be pressure to meet productivity targets and deadlines while maintaining accuracy and fairness in reviews. Collaboration with physicians, case managers, and insurance representatives is frequent, requiring strong communication and negotiation skills.

What is the difference between Utilization Review Physician Assistant vs Utilization Review Nurse Practitioner?

AspectUtilization Review Physician AssistantUtilization Review Nurse Practitioner
CredentialsMaster's degree, Physician Assistant (PA) license, certification (e.g., NCCPA)Master's or higher degree, Nurse Practitioner (NP) license, certification (e.g., ANCC, AANP)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, clinics, insurance companies
Employer & Industry UsageCommonly employed in healthcare and insurance sectors for review rolesSimilar usage, often in outpatient and insurance settings

Both roles involve reviewing medical necessity and appropriateness of care, but the Physician Assistant typically has a medical model training background, while the Nurse Practitioner has a nursing model. Both are vital in utilization review, with overlapping responsibilities and work environments.

Can physician assistants do utilization review?

Yes, physician assistants can perform utilization review tasks, which involve evaluating the necessity, appropriateness, and efficiency of healthcare services. They often work in collaboration with physicians and may require certification or training in utilization review processes, depending on the healthcare setting and state regulations.

What are popular job titles related to Utilization Review Physician Assistant jobs in Puerto Rico?

For Utilization Review Physician Assistant jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Utilization Review Physician Assistant jobs in Puerto Rico look for?

The top searched job categories for Utilization Review Physician Assistant jobs in Puerto Rico are:

What cities in Puerto Rico are hiring for Utilization Review Physician Assistant jobs?

Cities in Puerto Rico with the most Utilization Review Physician Assistant job openings:

Materials Planning Analyst

Nutanix

Coamo, PR • On-site

$60 - $80/hr

Other

Posted 5 days ago


Job description

Eaton’s ES AMER PCS division is currently seeking a Materials Planning Analyst.What you’ll do:Primary Function:The focus of the position is work together with supply chain and production teams to drive new planning strategies to continue supporting the business results in compliance with Eaton financial standards and policies. This employee will perform supply chain functions (planning, inventory management, logistics planning or purchasing activities) and will be responsible to support Supply Chain Team as Supply Chain Planner / Assistant. The candidate will analyze production requirements in terms of materials availability and capacity constraints to develop production schedules with optimum support of demands and utilization of resources to support the improvement of customer service metrics.Essential Functions:Assist in the development and implementation of procedures and techniques which will improve the planning function.Actively participate in process improvement and creation/adhering to standard work.Manage material flow (WIP – “work in process”) through analysis of diverse reports and perform critical analysis to avoid operation disruptions caused by material availability or constraints.Support the Clear to Build Planning Strategy and create optimized production plan considering different scenarios and production constraints.Analyzes material and capacity constraints together with Master Scheduler and develops alternative schedules to meet objectives based on materials available and drive properly and proactive communication to the Buyer Planners for material priorities and expedites.Daily review of customer requirements, production orders order confirmations and the creation of an appropriate weekly production schedules that will meet 100% OTD for customer orders.Responsible for issuing and resolving any production order issues in a timely manner.Responsible for observing good business practices, protecting the interest of the company and for buying at the best possible price consistent with time, quality and quantity requirements complying with company policies and procedures.Analyzes and schedules production activities to support forecast, target inventories, and multiple plant production activities.Daily communications with production area related to production plan progress based on plan previously agreed.Lead and/or participates in operations, tier meetings and other meetings related to Supply Chain.Run and analyze Past Due production orders to measure aging and support re-scheduling and resolution.Support Buyers on Invoices on Hold report, providing visibility and first line of resolution.Support special inventory strategies to drive company costs as VMI’s, Consignments Inventory, etc.Support all other activities related to position and or that is needed as per the company urgency.Ability to use digital tools to create, analyze and present information to facilitate the communication and departmental metrics.Qualifications:EDUCATION: Bachelor’s degree, prefer BBA or Engineering Sciences.EXPERIENCE: 1 year of related experience ManufacturingExcellent Communication skills in English Language / Eaton Cultural Model AttributesComputer Knowledge and Digital Mindset (Microsoft Programs, AS 400, MAPICS, Access), ERPFollow-up skills, be able to meet deadlines, drive for resultsStrong sense of urgency and accountability for resultsSome level of knowledge of purchasing processSome level of knowledge of Financial ProceduresWritten and verbal communication in English, preferred.Additional Information:Dimensions:Primary:Weekly Schedule AttainmentPast Due Backlog ReductionOTDSFRInventory TargetSecondary:QualityOther CST Metrics (to be determined)Guidance Received:Corporate Policies and ProceduresCode of EthicsDepartmental ProceduresThis position receives guidance from the Supply Chain Manager and Plant Controller and interacts with supply chain, production, and finance teams. Also, can interact with external plant colleagues in other sites as Haina, RD.Major or Unusual Problems:Balance of priorities between inventory, production, service, and cost.(Control and reduce inventory levels while the material is available to minimize air shipments and maintain established service levels.)External Contacts: Describe the nature and purpose of your contacts outside the Corporation.Suppliers (establish communication between our plant and suppliers)Corporate Supply Chain Commodity ManagersPrincipal Accountabilities: Describe five or six critical end results which your position is expected to accomplish.Develop optimal production plansMonitor service levelsBalance InventoryMonitor past due production order and support invoices on hold and drive resolution.Additional Information:This person needs to be firm in requesting response from the production team, buyers or Financial team and escalate appropriately if additional support is needed to drive expected results.Roles & Responsibilities of all The Associates (Mandatory Rules of Security)1) Request training in new tasks.2) Execute its function in agreement al training received.3) Use and personal protection equipment care.4) Correct utilization of the equipment of security in areas required.5) Act and to watch for its security and that of its peers.6) Report any insecure condition to its supervisor and/or Official of Security.7) Observe the rules of security established.8) Contribute with its ideas to improve the health and security of the plant.9) Be attentive to the prevention of accidents in its area of work.10) Know and to put in practice the Security Policy of the plant.#LI-CR1All positions may require participation in video and in-person interviews as part of the hiring process. All candidates will be evaluated based on job-related competencies, and all candidates’ privacy rights and data security will be protected in accordance with applicable laws.We are committed to ensuring equal employment opportunities for job applicants and employees. Our recruitment processes use balanced selection criteria and avoid unlawful discrimination against applicants on the basis of their age, colour, disability, marital status, national origin, gender, gender identity, genetic information, race or racial origin, religion, sexual orientation or any other status protected or required by law. #J-18808-Ljbffr