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Qualifications Registered Nurse, LPN, and/or a minimum of a Bachelor's Degree in Social Work or Psychology with experience in Utilization Review preferred. We are currently looking for a qualified Utilization Review Coordinator to join our team of dedicated Behavioral Health professionals.
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The role reflects appropriate knowledge of RN scope of practice, current state requirements, CMS Conditions of Participation, EMTALA, The Patient Bill of Rights, AB1203 and other Federal or State regulatory agency requirements specific to Utilization Review and Discharge Planning.
$50.24 - $72.85 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Job Overview: The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies. The Utilization Review Specialist provides appropriate client information to third party payers regarding the medical necessity of treatment in a timely manner.
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Interface with facility or hospital utilization review staff to facilitate proper coordination of care, transitions between care settings, and discharges. Assesses patient knowledge of kidney disease for barriers that may affect adherence to treatment.
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Including assisting with the coordination of daily staffing and patient scheduling, working with team members to meet productivity expectations and service demands, participating in utilization and peer review activities, and assists with ongoing feedback to team members regarding observed performance and talents to facilitate goal achievement.
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Conducts admission and continued stay review on groups of patients, in accordance with the PRO, special negotiated PPO and/or HMO contracts, and on other classifications of patients as designated by the Utilization/Case Management Review Plan. Coordinates patient care, in conjunction with the medical, nursing and other ancillary staff members.
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Registered Nurse, LPN, and/or a minimum of a Bachelor's Degree in Social Work or Psychology with experience in Utilization Review preferred. We are currently looking for a qualified Utilization Review Coordinator.
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Conduct utilization review, incident management and review and quality assurance reviews. Odyssey House provides high quality, holistic treatment impacting all major life spheres, including: psychological, physical, social, family, educational and spiritual in order to support personal rehabilitation, renewal and family restoration.
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Participates in performance improvement activities to evaluate and resolve problems related to risk management, utilization review, and quality assurance. Our mission expanded in 1988 to include homeless services and substance abuse treatment.
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Participates in quality assurance and utilization review activities as directed by the Facility COO. Experience working with substance abuse, addictions, mental health, cognitive behavior treatment and motivational interviewing.
$75,000 - $90,000 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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EzURS.com Inc., has an ongoing need for Physician Consultants to perform a wide variety of world-class utilization review, disability, peer reviews products in multiple lines of business including health, workers compensation, and auto liability.
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The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed. Three to Five (5) years experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, or Utilization Review Coordinator.
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Objective, Defensible, Evidenced-based assessment of the medical records focusing on diagnosis, mechanism of injury, current and past treatment rgimes allowing them to assess the appropriateness of care in a non-bias fashion.
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Demonstrates an understanding of the patient's clinical condition, social, and financial resources to determine the most appropriate care setting, practice standards for evaluation, treatment delivery options (Home, SAR, SNF, LTACH, Acute Rehabilitation, Assisted Living, Board/Care, Recuperative Care, Shelter), and resources required to support safe transition of care.
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EzURs is a URAC accredited Independent Review Organization. We have an immediate need of a Board Certified Neurologists to join our panel of reviewers reviewing for pre-authorizations, medication reviews and LTD/STD case, with an unrestricted license.
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