Utilization Review Manager Jobs Near Me

Utilization Review Specialist Job Summary: The Utilization Review (UR) Specialist is responsible ... Reports to: VP of Revenue Cycle Management Duties and Responsibilities: Duties include, but are not ...

UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. License:

Conducts utilization reviews of behavioral health cases to determine medical necessity ... Assists with retrospective reviews and denial management to maintain appropriate and cost-effective ...

UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. License:

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...

Well versed in Utilization Management - Must be able to determine elective vs urgent request with Prior Authorization Review * Provider Claims, Appeals and Denials - certain services require prior ...

Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...

Experience in utilization review, case management, medical records, or healthcare billing strongly preferred * Strong understanding of insurance authorization processes (Medicare, Medicaid, and ...

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...

For billing and hospitalization utilization review purposes, the reviewer will identify and certify ... Maintain compliancy with regulation changes affecting utilization management. PositionRequirements ...

High School Diploma/GED Required Experience: 0-2 years of experience in a Utilization Review Department in a Managed Care Environment. Previous Hospital or Healthcare clerical, audit or billing ...

Helping to manage an over $ 7million/ year hospital utilization contract * Reviewing necessary medical record reviews and making a determination on hospital appeals. * Supervising and training RNs, ...

Utilization Review/Management (UM) to secure necessary authorizations. Support with ongoing UM, as needed, including, but not limited to pre-certifications, renewal authorizations, denial appeals ...

Utilization Review/Management (UM) to secure necessary authorizations. Support with ongoing UM, as needed, including, but not limited to pre-certifications, renewal authorizations, denial appeals ...

Utilization Review/Management (UM) to secure necessary authorizations. Support with ongoing UM, as needed, including, but not limited to pre-certifications, renewal authorizations, denial appeals ...

Helping to manage an over $ 7million/ year hospital utilization contract * Reviewing necessary medical record reviews and making a determination on hospital appeals. * Supervising and training RNs, ...

Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab ... Case Management Team Lead * Assess documentation of medical records for completeness on a ...

Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab ... Case Management Team Lead * Assess documentation of medical records for completeness on a ...

Maintains knowledge of current concepts, researches needs and research strategies related to care coordination including case management, utilization review, and discharge planning. * Assists in ...

Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review ...