Utilization Review Technician jobs in Erie, PA

Utilization Review Technician conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Technician reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Technician consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). The Utilization Review Technician gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Utilization Review Technician typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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RN Peer Review Coordinator
  • Allegheny Health Network
  • Erie, PA FULL_TIME
  • Company :

    Allegheny Health Network

    Job Description :

    GENERAL OVERVIEW:

    The Peer Review Coordinator will support the hospital's medical staff peer review function in compliance with legal and regulatory standards, CMS Conditions of Participation and the Medical Staff Bylaws. The Peer Review Coordinator will oversee the day to day peer review process including acceptance of cases for peer review, facilitating first level screening if applicable, preparation of case review documents, documentation of peer review results, production of reports and maintenance of the peer review records. This person will remain current and insure compliance with peer review state statues, federal requirements, medical staff bylaws, internal policies and procedures, and Joint Commission regulations. They will be responsible for the education of the peer review process to hospital leadership, medical staff, and quality staff as appropriate. This position will support the medical staff and medical committees with a focus on peer review such as MSQI, service line committees and the organization through use of clinical expertise in review of concerns regarding quality of clinical care. The Peer Review Specialists collaborates with the medical staff leadership including multiple hospitals Peer Review Committees, The Medical Executive Committee (MEC), and the Medical Research, Education and Affairs Committee.

    This person will collaborate with members of the Risk Management, Patient Safety and Quality, Information Technologies, Clinical Resource Management and others as needed to obtain information related to performance of peer duties and responsibilities. Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Allegheny Health Network.

    ESSENTIAL RESPONSIBILITIES:

    • Oversees the day to day peer review process from acceptance of cases for peer review, facilitating first level screening if applicable, preparation of case review documents, documentation of peer review results, production of reports and maintenance of the peer review records. (20%)
    • Ensures compliance to all standards and regulations involving medical staff peer review. Also, ensures compliance with the peer review process as outlined in the Medical Staff Bylaws and regulatory requirements. Proactively reviews professional sources for changes in the peer review process, regulatory changes, and legal. Responds to external audits triggered by quality incidence or performance issues. (20%)
    • Secures all documents utilizing legal peer review protection. Maintains systems and processes of review (Paper, Electronic) per applicable regulations and laws for confidentiality and record maintenance. (15%)
    • Develops a mechanism to distribute peer review findings and actions throughout the organization while preserving confidentiality. Cultivates a supportive and accountable warning / escalation system regarding peer review. (15%)
    • Schedules and prepares for meetings as appropriate (Room reservations, agenda management, minutes, food, equipment, etc). Collaborates with physician leadership regarding peer review for hospital level meetings ie: Medical Staff Quality Improvement (MSQI), Department Peer Review Meetings; Orthopaedic (Ortho), Obstetric/Gynecologic (Ob/Gyn), Pediatric (Peds), Trauma Transportable Physician Orders for Patient Preference/Peer Review (Trauma TPOPP/Peer Review) , Surgery, etc. Incorporates information from RL Solutions reports, adverse events, and other sources into the peer review process. (20%)
    • Ensures confidentiality with patient and physician information, PHI, and demonstrates understanding of HIPAA. (5%)
    • Answers the phones and responds to customer needs professionally. Participates willingly in department meetings to enhance team work and efficiency within the department. Willingly takes on additional assignments as needed within the department. (5%)

    QUALIFICATIONS:

    QUALIFICATIONS:

    Minimum

    • 3-5 years of previous clinical experience
    • Registered Nurse (RN)

    Preferred

    • Bachelor’s Degree in Healthcare or Business
    • 3-5 years of previous quality improvement or patient safety experience

    SKILLS:

    • Ability to define problems, collect data, establish facts, and draw valid conclusions
    • Ability to use word processing, spreadsheet, power point presentation, and third party vendor specific software (Midas, RL Solutions, etc)
    • Advanced knowledge of healthcare regulations, accreditation guidelines and standards related to the peer review process
    • Positive and highly effective interpersonal and written and verbal communication skills
    • Ability to work effectively with various levels of management personnel, physicians, board members, and other community members
    • Advanced skills in leadership and facilitation, decision-making, change management and conflict resolution
    • Excellent Time Management And Organizational Skills
    • Excellent analytical, critical thinking, and problem-solving skills
    • Ability to manage multiple priority projects simultaneously
    • Able to work flexible hours as needed
    • Able to work effectively and efficiently under tight deadlines, high volumes and multiple interruptions
    • Demonstrates ability to maintain information in a confidential manner

    Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

    Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.


    As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

    Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

    Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

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    Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

    We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

    For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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  • 1 Month Ago

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Paid Product Tester
  • Product Review Jobs
  • Cranesville, PA FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • Just Posted

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Paid Product Tester
  • Product Review Jobs
  • Hydetown, PA FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • Just Posted

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Paid Product Tester
  • Product Review Jobs
  • Mills, PA FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • Just Posted

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RN Peer Review Coordinator (Full Time), St. Vincent
  • Allegheny Health Network
  • Erie, PA FULL_TIME
  • Company : Allegheny Health Network Job Description : St. Vincent Hospital St. Vincent Hospital is a Magnet®-designated hospital for excellence in nursing, serving the people in the Lake Erie region si...
  • 1 Month Ago

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Medical Review Office Assistant (Certified Medical Assistant) - Occupational Health Office - Erie
  • Allegheny Health Network
  • Erie, PA FULL_TIME
  • Company : Allegheny Health Network Job Description : GENERAL OVERVIEW : Works directly under a licensed physician that is a Medical Review Officer to organize and facilitate the drug testing process. ...
  • 10 Days Ago

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0 Utilization Review Technician jobs found in Erie, PA area

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Cyber Warfare Technician
  • US Navy
  • Erie, PA
  • About Enlisted Sailors in the Navy Cryptology community analyze encrypted electronic communications, jam enemy radar sig...
  • 3/28/2024 12:00:00 AM

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Ophthalmic Technician with Bonus!
  • Edward M Zimm Pc
  • Erie, PA
  • Zimm Cataract & Laser Center has an opening for an energetic Ophthalmic Technician to join our team. Located in downtown...
  • 3/28/2024 12:00:00 AM

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Assembly Technician
  • Career Concepts
  • Corry, PA
  • Assembly Technician An assembly technician is responsible for assembling various components and parts to create finished...
  • 3/27/2024 12:00:00 AM

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Biomedical Equipment Technician
  • Veterans Professional Services, LLC
  • Erie, PA
  • Job Description Job Description DUTIES: First response level maintenance, repairs, and preventive maintenance (PM) for g...
  • 3/26/2024 12:00:00 AM

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Cultivation Technician
  • J.L. Nick & Associates
  • Erie, PA
  • Cultivation Technician Our client, a regional medical agriculture facility, has an immediate need for a Cultivation Tech...
  • 3/25/2024 12:00:00 AM

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Maintenance Technician
  • Welch's
  • North East, PA
  • MAINTENANCE TECHNICIAN *** $3,500 Sign-on Bonus *** Position Overview: As a maintenance technician, you will be responsi...
  • 3/25/2024 12:00:00 AM

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Pharmacy Technician
  • Community Health Net
  • Erie, PA
  • SUMMARY Under the direction of a licensed Pharmacist fills medication orders and other health care products for Communit...
  • 3/24/2024 12:00:00 AM

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Desktop Support Technician
  • Pomeroy Technologies, LLC.
  • Erie, PA
  • Job Description Job Description Pomeroy is looking to add an experienced Desktop Support Level 2 Technician to join our ...
  • 3/24/2024 12:00:00 AM

Erie (/ˈɪəri/; EER-ee) is a city on the south shore of Lake Erie and the county seat of Erie County, Pennsylvania, United States. Named for the lake and the Native American Erie people who lived in the area until the mid-17th century, Erie is the fourth-largest city in Pennsylvania, as well as the largest city in Northwestern Pennsylvania, with a population of 101,786 at the 2010 census. The estimated population in 2017 had decreased to 97,369. The Erie metropolitan area, equivalent to all of Erie County, consists of 276,207 residents. The Erie-Meadville, PA Combined Statistical Area has a pop...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Technician jobs
$57,977 to $80,898
Erie, Pennsylvania area prices
were up 1.5% from a year ago

Utilization Review Technician in Winston Salem, NC
When considering cost of living, this places Durham, NC as 3rd out of the 4 largest nearby metros in terms of quality of life for Utilization Review Technicians**.
January 02, 2020
Utilization Review Technician in Fairbanks, AK
Current National Pharmacy Technician Certification (PTCB, ExCPT or NCCT) required.
February 03, 2020
Utilization Review Technician in Little Rock, AR
Based on our compensation data, the estimated salary potential for Utilization Review Technician will increase 16 % over 5 years.
February 07, 2020