Insurance Utilization Manager/Review and Millemen Experience (MCG). No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past ...
Insurance Utilization Manager/Review and Millemen Experience (MCG). No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past ...
Utilization Review Specialist Job Summary: The Utilization Review (UR) Specialist is responsible ... Submit authorization requests and clinical documentation to insurance providers in a timely manner
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Utilization Review Specialist Job Summary: The Utilization Review (UR) Specialist is responsible ... Submit authorization requests and clinical documentation to insurance providers in a timely manner
New
Utilization Review Specialist
Columbus, OH · On-site
Utilization Review Specialist Job Summary: The Utilization Review (UR) Specialist is responsible ... Submit authorization requests and clinical documentation to insurance providers in a timely manner
New
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Utilization Review Specialist
Columbus, OH · On-site
Utilization Review Specialist Job Summary: The Utilization Review (UR) Specialist is responsible ... Submit authorization requests and clinical documentation to insurance providers in a timely manner
New
Utilization Review Specialist
Columbus, OH · On-site
Utilization Review Specialist Job Summary: The Utilization Review (UR) Specialist is responsible ... Submit authorization requests and clinical documentation to insurance providers in a timely manner
Utilization Review Specialist
Columbus, OH · On-site
Utilization Review Specialist Job Summary: The Utilization Review (UR) Specialist is responsible ... Submit authorization requests and clinical documentation to insurance providers in a timely manner
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ...
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ...
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ...
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ...
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ...
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ...
Utilization Review Specialist
West Chester, OH · On-site
$10/hr
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 Specialist
West Chester, OH · On-site
$10/hr
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 Specialist
West Chester, OH · On-site
$10/hr
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 Specialist
West Chester, OH · On-site
$10/hr
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 Specialist (UR), Behavioral Health Full-time Your experience matters Beckett ... Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability ...
Utilization Review Specialist (UR), Behavioral Health Full-time Your experience matters Beckett ... Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability ...
Utilization Review Specialist (UR), Behavioral Health Full-time Your experience matters Beckett ... Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability ...
Utilization Review Specialist (UR), Behavioral Health Full-time Your experience matters Beckett ... Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability ...
This role will review patient medical records to ensure accurate documentation, proper level of ... Strong verbal and written communication skills to interact with physicians and insurance payers.
This role will review patient medical records to ensure accurate documentation, proper level of ... Strong verbal and written communication skills to interact with physicians and insurance payers.
This role will review patient medical records to ensure accurate documentation, proper level of ... Strong verbal and written communication skills to interact with physicians and insurance payers.
This role will review patient medical records to ensure accurate documentation, proper level of ... Strong verbal and written communication skills to interact with physicians and insurance payers.
This role will review patient medical records to ensure accurate documentation, proper level of ... Strong verbal and written communication skills to interact with physicians and insurance payers.
This role will review patient medical records to ensure accurate documentation, proper level of ... Strong verbal and written communication skills to interact with physicians and insurance payers.
Utilization Management Clinical Specialist
Columbus, OH · On-site
$72K - $88K/yr
Medical Insurance * Flexible Benefit Options Including Dental, Vision and Wellness Support ... reviews, and facilitate timely authorization processes. The UM Clinical Specialist ensures ...
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Utilization Management Clinical Specialist
Columbus, OH · On-site
$72K - $88K/yr
Medical Insurance * Flexible Benefit Options Including Dental, Vision and Wellness Support ... reviews, and facilitate timely authorization processes. The UM Clinical Specialist ensures ...
New
Registered Nurse, Utilization Mgmt
Dayton, OH · On-site +1
$76K - $163K/yr
As a clinical reviewer he/she serves as the QM liaison creating effective lines of communication ... Federal health/vision/dental/term life/long-term care (many federal insurance programs can be ...
Registered Nurse, Utilization Mgmt
Dayton, OH · On-site +1
$76K - $163K/yr
As a clinical reviewer he/she serves as the QM liaison creating effective lines of communication ... Federal health/vision/dental/term life/long-term care (many federal insurance programs can be ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
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Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Medical terminology training and experience in medical or insurance field preferred. * For URAC ...
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Works with the Utilization Management team primarily responsible for inpatient medical necessity ... Insurance experience PLUS . Required Experience: Minimum 3-4 years of clinical practice in hospital ...
Works with the Utilization Management team primarily responsible for inpatient medical necessity ... Insurance experience PLUS . Required Experience: Minimum 3-4 years of clinical practice in hospital ...
Supervises prior authorization utilization review nurses ensuring they appropriately apply medical ... a Nurse Reviewer in health insurance prior authorization or clinical appeals, or equivalent ...
Supervises prior authorization utilization review nurses ensuring they appropriately apply medical ... a Nurse Reviewer in health insurance prior authorization or clinical appeals, or equivalent ...
Initiate admission and concurrent medical record review on Medicare, Medicaid and private insurance ... For billing and hospitalization utilization review purposes, the reviewer will identify and certify ...
Initiate admission and concurrent medical record review on Medicare, Medicaid and private insurance ... For billing and hospitalization utilization review purposes, the reviewer will identify and certify ...
Weekday Insurance Utilization Review information
What is the difference between Weekday Insurance Utilization Review vs Weekday Claims Processor?
| Aspect | Weekday Insurance Utilization Review | Weekday Claims Processor |
|---|---|---|
| Primary Role | Assessing medical necessity and appropriateness of services | Processing and reviewing insurance claims for payment |
| Credentials | Often requires healthcare or insurance certifications | Typically requires insurance or administrative experience |
| Work Environment | Healthcare settings, insurance companies | Insurance companies, healthcare offices |
| Focus | Medical review and authorization | Claims data entry and verification |
Weekday Insurance Utilization Review focuses on evaluating medical necessity, while Weekday Claims Processors handle the administrative processing of insurance claims. Both roles are essential in the insurance industry but serve different functions related to claims management and healthcare authorization.
What are the most commonly searched types of Insurance Utilization Review jobs in Ohio? The most popular types of Insurance Utilization Review jobs in Ohio are:
What cities in Ohio are hiring for Weekday Insurance Utilization Review jobs? Cities in Ohio with the most Weekday Insurance Utilization Review job openings:
Job description
Company Description
Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.
We've stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.
Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients' success.
Job Description
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
Medicaid Division
Duties: Review cases for in patients/in hospital: skilled care, acute rehab and long term acute care
Nurses working at the facilities Members are being care for, will be sending over clinical information to be reviewed by the Care Review Clinician. Therefore, this agent will not be traveling and will be reviewing information at the office.
Qualifications
BackgroundÂ
Hospital Utilization Management. Insurance Utilization Manager/Review and Millemen Experience (MCG). No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past hospital experience (3-4 years of experience, less experience is ok if they have more Utilization Review experience)Â
Potential for longer term dependent on enrollmentÂ
Workers will be doing Concurrent Inpatient ReviewÂ
MUST have one of the following AT LEASTÂ
-Utilization Review in hospital settingÂ
Nurses who are used to doing both production and review work
Additional Information
All your information will be kept confidential according to EEO guidelines.
About Integrated Resources
Sourced by ZipRecruiter
Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.
Industry
Recruiting and staffing services
Company size
51 - 200 Employees
Headquarters location
Edison, NJ, US
Year founded
1996