45 results for Utilization Review Specialist Jobs

Position DescriptionThe Fresno County Department of Behavioral Health invites applications for the position of Utilization Review Specialist. Incumbents provide professional services including: regulatory interpretation and guidance; review of health records, policies, and facilities to ensure prope...

About UsBakersfield Behavioral Healthcare Hospital, located in Bakersfield, California, is an acute psychiatric and behavioral 90 bed facility situated on 8.8 acres.We offer inpatient and outpatient services for children, adolescents and adults needing mental/behavioral health, chemical dependency; ...

Responsible for advocating for patient coverage by displaying knowledge of clinical criteria and managed care requirements, reporting denial and authorization information, ensuring documentation compliance, and interfacing with managed care organizations and external reviews.

Responsible for completing pre and re-certifications for inpatient and outpatient services, advocating for patients to secure coverage for needed services, communicating with the interdisciplinary team, and participating in treatment teams to ensure knowledge of coverage.

Responsible for performing admission and concurrent stay medical record reviews, determining appropriateness of admissions and continued stays, collaborating with healthcare providers, communicating with third-party payors for authorizations, and assisting with denial management. Ensures regulatory ...

Essential FunctionsAct as liaison between managed care organizations and the facility professional clinical staff.Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimburs...

JOB The Fresno County Department of Behavioral Health invites applications for the position of Utilization Review Specialist. Incumbents provide professional services including: regulatory interpretation and guidance; review of health records, policies, and facilities to ensure proper utilization of...

General Summary:Responsible for supporting the utilization review system including data analysis, report writing, and program improvement.UR Specialist will develop and maintain a VOD Tracking and Receipt system. UR Specialist will maintain an expert level review of client entitlements and billing a...

Spectrum Billing Solutions is an industry-leading revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing team. The UR Specialist will utilize his or her knowledge and skills to review clinical information and obtain in...

Copper Springs, part of Lifepoint Behavioral Health, nationally known healthcare organization with diversified delivery network with facilities from coast to coast, seeks passionate, patient-centric, and goal-oriented team members to join our team. We specialize in compassionate behavioral health se...