Brookfield, WI · On-site +1
Utilization Review Specialist - Behavioral Health Facility We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing ...
Brookfield, WI · On-site +1
Utilization Review Specialist - Behavioral Health Facility We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing ...
Brookfield, WI · On-site +1
Utilization Review Specialist - Behavioral Health Facility We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing ...
Quick apply
Brookfield, WI · On-site +1
Utilization Review Specialist - Behavioral Health Facility We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing ...
Menomonee Falls, WI · On-site
$34 - $52.70/hr
Refers cases to the physician advisor, PA moonlighter, for a second level review as needed ... Utilization of Interqual, MCG care web QI or Indicia evidence based guidelines is strongly ...
Menomonee Falls, WI · On-site
$34 - $52.70/hr
Refers cases to the physician advisor, PA moonlighter, for a second level review as needed ... Utilization of Interqual, MCG care web QI or Indicia evidence based guidelines is strongly ...
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
Menasha, WI · On-site +1
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
Menasha, WI · On-site +1
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
This position reviews applicable guidelines regarding payment and coverage, and makes ... Utilization Management Inter-reviewer reliability and denial files) * Refer all members with ...
Middleton, WI · On-site +1
$71K - $151K/yr
Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the revenue cycle program and functions within the scope ...
Middleton, WI · On-site +1
$71K - $151K/yr
Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the revenue cycle program and functions within the scope ...
Milwaukee, WI · On-site
$36.38 - $56.39/hr
Shift 1 Shift Details: 1/2 day Wednesday, Thursday and Friday Holidays : no Weekends : no Job ... Assists the case managers with utilization review issues, and provides recommendations for process ...
Milwaukee, WI · On-site
$36.38 - $56.39/hr
Shift 1 Shift Details: 1/2 day Wednesday, Thursday and Friday Holidays : no Weekends : no Job ... Assists the case managers with utilization review issues, and provides recommendations for process ...
... weekends Compassion. Accountability. Collaboration. Foresight. Joy. These are the Aspirus Core ... Knowledge of utilization review standards and patient care practices normally acquired through ...
... weekends Compassion. Accountability. Collaboration. Foresight. Joy. These are the Aspirus Core ... Knowledge of utilization review standards and patient care practices normally acquired through ...
Union Position: No Department Details Oversee health plan utilization management department ... Actively involved in reviewing information submitted by internal or external referral sources ...
Union Position: No Department Details Oversee health plan utilization management department ... Actively involved in reviewing information submitted by internal or external referral sources ...
Wauwatosa, WI · On-site
$33.05 - $49.60/hr
Per weekend program policy one weekend off per quarter. Pay Range $33.05 - $49.60 Major ... utilization review in a managed care environment. Knowledge, Skills & Abilities Required:
Wauwatosa, WI · On-site
$33.05 - $49.60/hr
Per weekend program policy one weekend off per quarter. Pay Range $33.05 - $49.60 Major ... utilization review in a managed care environment. Knowledge, Skills & Abilities Required:
Wauwatosa, WI · On-site
$33.05 - $49.60/hr
Per weekend program policy one weekend off per quarter. Pay Range $33.05 - $49.60 Major ... utilization review in a managed care environment. Knowledge, Skills & Abilities Required:
Wauwatosa, WI · On-site
$33.05 - $49.60/hr
Per weekend program policy one weekend off per quarter. Pay Range $33.05 - $49.60 Major ... utilization review in a managed care environment. Knowledge, Skills & Abilities Required:
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise clients on network strategy, provider capacity,utilizationtrends, access challenges, and market ...
As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise clients on network strategy, provider capacity,utilizationtrends, access challenges, and market ...
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
$21.59 - $25.96
2% of jobs
$25.96 - $30.33
9% of jobs
$33.32 is the 25th percentile. Wages below this are outliers.
$30.33 - $34.70
21% of jobs
The median wage is $38.23 / hr.
$34.70 - $39.06
23% of jobs
$39.06 - $43.43
13% of jobs
$46.83 is the 75th percentile. Wages above this are outliers.
$43.43 - $47.80
10% of jobs
$47.80 - $52.17
8% of jobs
$52.17 - $56.53
5% of jobs
$56.53 - $60.90
5% of jobs
$60.90 - $65.27
2% of jobs
$65.27 - $69.64
2% of jobs
$21
$42
$69
Weekend Utilization Review professionals typically work independently, reviewing patient cases for medical necessity, appropriateness of care, and compliance with payer guidelines during non-standard business hours. You will analyze patient charts, interact with clinical staff, and document findings, often collaborating remotely with other care coordinators or medical teams. While much of the role is desk-based, quick decision-making and effective communication are essential due to faster-paced weekend workflows. This schedule can offer greater autonomy and flexibility, but may also require prioritizing tasks and managing multiple cases efficiently to ensure continuous patient care.
A Weekend Utilization Review job involves assessing patient care and medical services during weekends to ensure they meet medical necessity and insurance guidelines. Professionals in this role review clinical documentation, coordinate with healthcare providers, and determine appropriate levels of care for patients. They typically work for hospitals, insurance companies, or other healthcare organizations. Strong analytical skills, medical knowledge, and familiarity with regulatory requirements are essential for success in this role.
Success as a Weekend Utilization Review professional requires a strong background in nursing or healthcare, critical thinking skills, and a thorough understanding of medical necessity criteria, such as InterQual or Milliman guidelines. Familiarity with electronic medical records (EMR) systems and utilization management software is highly beneficial, and RN or healthcare-related licensure is often required. Exceptional communication, attention to detail, and the ability to work independently on weekends are crucial soft skills. Mastering these areas allows efficient and accurate reviews of patient care, supporting optimal healthcare resource allocation outside of standard work hours.
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 3 days ago
Utilization Review Specialist – Behavioral Health Facility
We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing clinical documentation, ensuring medical necessity, managing insurance authorizations, and collaborating with providers to support appropriate and timely care for our clients.
Responsibilities:
Conduct utilization reviews and obtain prior authorizations from insurance companies
Monitor continued stay and discharge criteria for clients
Communicate effectively with clinical and administrative teams
Maintain accurate and up-to-date documentation
Ensure all documentation meets insurance and regulatory compliance standards and is completed accurately and on time.
Qualifications:
Background or experience in social work, counseling, or behavioral health is preferred
Experience in utilization review or case management for behavioral health is preferred
Strong communication and organization skills
Ability to work efficiently in a fast-paced environment
Confident, proactive, and dedicated work ethic
Benefits: Competitive salary Opportunities for professional development and career advancement Supportive and collaborative work environment Fulfilling work helping individuals with mental health or substance abuse issues
Benefits:
401(k)
Dental insurance
Flexible schedule
Health insurance
Life insurance
Paid time off
Vision insurance
