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Utilization Review Specialist jobs in Texas

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UTILIZATION REVIEW SPECIALIST

Oversees all functions of a virtual IOP caseload. Completes peer reviews on cases with insurance. Collaborates at a high level to problem solve on complex cases with Manager. Completes pre-certs and continued stay authorizations f...

CompanyCharlie Health
AddressRemote
CategoryHuman Resources
Salary$61K - $77.2K a year
Job typeFull-time
Date Posted a month ago See detail

Utilization Review Specialist

Charlie Health

Remote

$61K - $77.2K a year

Oversees all functions of a virtual IOP caseload. Completes peer reviews on cases with insurance. Collaborates at a high level to problem solve on complex cases with Manager. Completes pre-certs and continued stay authorizations f...

a month ago seen See more...

Specialist - Utilization Review - Full Time, Days (Hollywood)

Prospect Medical Holdings

California, United States

From $23.20 an hour

Interfaces with all payors and providers requesting authorizations, medical records, and other specific information. Completes payor and provider request for missing or additional documentation. Logs all authorization requests to...

2 months ago seen See more...

RN Utilization Review Ananlyst- 31501224

Allmed Staffing Inc

Maryland, United States

Ability to sit at a desk 50% of the time and utilize the computer, telephone, and other office equipment, throughout the entire work day; walking and standing ? Time-management: Ability to effectively manage one's time and resourc...

3 weeks ago seen See more...

Clinical/Utilization Review Nurse

Aspirion Health Resources Llc

Remote

From $68,000 a year

Manages complex and robust queue according to Aspirion and client needs. Queue size varies weekly. Reviews insurance denials, including but not limited to, medical necessity denials, patient status denials (i.e., Inpatient vs. Out...

4 weeks ago seen See more...

Utilization Review Coordinator Lead

Umpqua Health

Remote

$61.3K - $77.6K a year

Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and internal and external guidelines. Leads also provide oversight, monitoring and training of thes...

4 weeks ago seen See more...

Utilization Review Nurse (RN)

Managed Resources, Inc

Remote

$38 - $42 an hour

401(k). 401(k) matching. Dental insurance. Disability insurance. Employee assistance program. Flexible spending account. Health insurance. Life insurance. Paid time off. Referral program. Vision insurance. Pet Insurance. Monthly I...

4 weeks ago seen See more...

Utilization Review RN

Ust

United States

$60,000 - $90,000 a year

Review, research and authorize requests for authorization of elective, direct, ancillary, urgent, emergency, etc. services. Contact appropriate medical and support personnel to identify and recommend alternative treatment, service...

4 weeks ago seen See more...

Behavioral Health Care Advocate - Utilization Review (Outpatient) - Remote

Optum

Minnesota, United States

$58,300 - $114,300 a year

Focus on outpatient Commercial, Medicaid and Medicare Behavioral Health services. Conducting outpatient reviews to determine appropriate care. Assessing if member care meets coverage guidelines. Shaping member treatment in partner...

4 weeks ago seen See more...

Utilization Review Nurse- PRN

Netsmart Technologies

Remote

$77.6K - $98.3K a year

Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual or MCG criteria. Participate in telephonic discussions with emergency department physicians relative to documen...

a month ago seen See more...

Utilization Review Author

R1 Rcm, Inc.

Remote

$24.00 - $41.68 an hour

Perform initial admission and continued stay reviews utilizing InterQual and MCG using evidenced-based criteria to identify and support the appropriate level of care Abstract data from a variety of medical records to ensure accura...

a month ago seen See more...

RN Utilization Review- Allegheny Health Network

Highmark Health

Remote - Pennsylvania, United States

Obtains or ensures acquisition of appropriate pre-certifications/authorizations from third party payers and placement to appropriate level of care prior to hospitalization utilizing medical necessity criteria and third party payer...

a month ago seen See more...

Utilization Review RN

Billings Clinic

Montana, United States

Coordinates with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days. )*If attending is unable to provide additional clinical information supporting status...

a month ago seen See more...

HP Utilization Review Nurse

Point32Health

Remote

$92K - $116K a year

Provides all aspects of clinical decision making and support needed to perform utilization management, medical necessity determinations and benefit determinations using applicable coverage documents, purchased clinical guidelines...

2 months ago seen See more...

Utilization Review Nurse

Veritas Allies, Llc

Remote

$65.7K - $83.2K a year

401(k). Health insurance. 8 hour shift. Day shift. Monday to Friday. Utilization review: 1 year (Required). RN (Required)....

2 months ago seen See more...

Utilization Review Nurse - LTSS

Villagecare Of New York

Remote

$90,000 - $105,000 a year

Reviews planned, in process, or completed health care services to ensure medical necessity and effectiveness according to evidence-based criteria - prospective, concurrent and retrospective review. Frequently collaborates and comm...

2 months ago seen See more...

UTILIZATION REVIEW (UR) COORDINATOR - FULL-TIME

River Oaks Hospital

Louisiana, United States

$45.4K - $57.5K a year

Experience: 3-5 years clinical experience with a psychiatric mental health population desired. Education: Bachelors prepared healthcare professional (Nursing, Counseling, Psychology or Social Work). Masters preferred. Licensure/Ce...

2 months ago seen See more...

Case Management Nurse Utilization Review Inpatient: Remote

Florida Health Care Plans, Inc.

Florida, United States

$68.8K - $87.2K a year

Current licensure in Florida as a Registered Nurse. Minimum of 3 years clinical experience; acceptable areas include Ambulatory Care, Medical/Surgical, or ICU required. Previous experience with referrals, Case Management, pre-cert...

2 months ago seen See more...

Manager of Utilization Review

Charlie Health

Remote

$79.9K - $101K a year

Interviewing, hiring, training and onboarding new teammates. Acting as a liaison between UR and other CH Departments (RCM, Clinical, Operations, Outreach/Admissions). Supporting the development, implementation, and evaluation of d...

2 months ago seen See more...

Case Management Assistant Utilization Review

Inova Health System

United States

Conducts timely arrangements of services to meet customer requirements. Addresses and solves provider and payor issues quickly with support from Case Management staff and performs other duties as assigned. Communicates financial a...

2 months ago seen See more...

RN Remote- Prior Authorization/Utilization Review

A-Line Staffing Solutions

Remote - Oregon, United States

You will also oversee fax processing and provide telephone call assistance for prescriber office staff pharmacies and members based on program criteria. Select applicable value: _N/A - Not RAMP Related Duties: 1.Effectively manage...

2 months ago seen See more...

Utilization Management Reviewer I

Crawford & Company

United States

$75.3K - $95.3K a year

Uses clinical RN or RPT training and knowledge to render authorization decisions of medical necessity of requested medical treatment. Analyzes medical information and applies clinical knowledge and established criterion to facilit...

4 weeks ago seen See more...

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What are the top cities in Texas open Utilization Review Specialist jobs?

There are open Utilization Review Specialist jobs in several cities including San Jose, Melbourne, Battle Creek, Somersworth, Columbia, Skokie, Englewood, Traverse City, Falmouth, Oak Ridge, Reading, Midvale, Williamsburg, Salt Lake City, Las Cruces,

What companies are hiring for Utilization Review Specialist jobs in Texas?

The top companies hiring now for Utilization Review Specialist jobs are Advanced Recovery Systems, Austin Treatment Centers, Brighton Recovery Center, Bronson Behavioral Health Hospital, Catholic Charities - Diocese of Trenton, Catholic Charities, Diocese of Trenton, Circles of Care, Inc., Cove Forge Behavioral Health, Denver Springs, Ensemble Health Partners, Providence Health Plan, Receivable Solutions, LLC, Ridgeview Behavioral Health Services, Skyway Behavioral Health, Spectrum Billing Solutions,

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