Utilization Review Technician jobs in Mississippi

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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Utilization Review Coordinator
  • Oceans Healthcare
  • Jackson, MS FULL_TIME
  • Oceans Healthcare will expand behavioral health services in Jackson, opening fall 2024. Oceans Healthcare of Jackson, a 77-bed facility will expand inpatient capacity for adult and senior behavioral health patients and add new services, including an intensive outpatient program. The freestanding hospital will be located on the St. Dominic's campus.

     

    Opening Fall 2024

     

    The Utilization Review Coordinator is responsible for management of all utilization review and case management activities for the facility’s inpatient, partial hospitalization, and outpatient programs.  Conducts concurrent reviews of all medical records to ensure criteria for admission and continued stay are met and documented, and to ensure timely discharge planning.  Coordinates information between third party payers and medical/clinical staff members.  Interacts with members of the medical/clinical team to provide a flow of communication and a medical record which documents and supports level and intensity of service rendered.  All duties to be done in accordance with Joint Commission, Federal and State regulations, Oceans' Mission, policies and procedures and Performance Improvement Standards.

     

    Essential Functions:

    1. Identifies and reports appropriate use, under-use, over-use and inefficient use of services and resources to ensure high quality patient care is provided in the least restrictive environment and in a cost-effective manner.
    2. Conducts review of all inpatient, partial hospitalization, and outpatient records as outlined in the Utilization Review/Case Management plan to (1) determine appropriateness and clinical necessity of admissions, continued stay, and or rehabilitation, and discharge; (2) determine timeliness of assessments and evaluations; i.e. H&Ps, psychiatric evaluation, CIA formulation, and discharge summaries; and (3) identify any under-, over-, and/or inefficient use of services or resources.
    3. Reports findings to appropriate disciplines and/or committees; notifies appropriate staff members of any deficiencies noted so corrective actions can be taken in a timely manner; submits monthly report to PI Coordinator of findings and actions recommended to correct identified problems.
    4. Coordinates flow of communication between physicians/staff and third party payers concerning reimbursement requisites
    5. Attends mini-treatment team and morning status meetings each weekday to obtain third-party payer pre-certification and ongoing certification requirements and to share with those attending any pertinent data from third-party payer contracts.
    6. Attends weekly treatment team.
    7. Conducts telephone reviews to, and follows through with documentation requests from third party payers.
    8. Maintains abstract with updates provided to third party payers.
    9. Notifies physicians/staff/patients of reimbursement issues.
    10. Initiates and completes appeals process for reimbursement denials; notifies inpatients of denials received.
    11. Reports monthly all Hospital Issued Notices of Non-coverage (HINN letter) to QIO.
    12. Conducts special retrospective studies/audits when need is determined by M&PS and /or other committee structure.
    13. Ensures all authorization and denied information is in HCS at the end of each business day.
    14. Performs other duties and projects as assigned.
  • Just Posted

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Utilization Review Coordinator
  • Oceans Healthcare
  • Biloxi, MS FULL_TIME
  • The Utilization Review Coordinator is responsible for management of all utilization review and case management activities for the facility’s inpatient, partial hospitalization, and outpatient programs...
  • 6 Days Ago

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Utilization Review Case Manager - Part-time
  • ignoredontpost
  • Branch, MS PART_TIME
  • Responsibilities: Parkwood Behavioral Health System (a UHS facility): Parkwood Behavioral Health System provides behavioral health and chemical dependency services to the Mid-South region and has been...
  • 18 Days Ago

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Case Management/Utilization Review/Discharge Planner
  • ALLEGIANCE SPECIALTY HOSPITAL OF GREENVILLE LLC
  • Greenville, MS FULL_TIME
  • Description Job Summary:cost effective care through ongoing monitoring and communication with patient, physicians, and care givers.Requirements Regulatory Requirements:Current Licensed Practical Nurse...
  • 18 Days Ago

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Case Management/Utilization Review/Discharge Planner
  • Freedom Behavioral Hospital of Greenville
  • Greenville, MS FULL_TIME
  • Job Summary: Assesses, plans, implements, and evaluates the needs of patients. The LPN case manages is responsible to evaluate each admission to determine if InterQual criteria for severity of illness...
  • 18 Days Ago

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Utilization Review Specialist - Bachelor's Social Work License
  • Acadia Behavioral Health (Pioneer Behavioral Health)
  • Magee, MS FULL_TIME
  • Employment Type: Full-Time Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concer...
  • 18 Days Ago

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Billing Technical Expert
  • Grow Therapy
  • New York, NY
  • About us: Grow Therapy is on a mission to serve as the trusted partner for therapists growing their practice, and patien...
  • 3/29/2024 12:00:00 AM

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System Integration Technical Expert
  • Traxen
  • Plymouth, MI
  • We are a Plymouth, Michigan based startup, developing cutting-edge technologies for Driver Assistance and Automated Driv...
  • 3/28/2024 12:00:00 AM

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Technical Specialist
  • Codebase Inc
  • Wilmington, DE
  • Title: JAVA/Golang Tech Specialist (10+yrs profiles) Location: Wilmington, Delaware (Hybrid model) Key Skills Required: ...
  • 3/28/2024 12:00:00 AM

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Display Application Technical Expert
  • Ford
  • Dearborn, MI
  • Job Description We are the movers of the world and the makers of the future. We get up every day, roll up our sleeves an...
  • 3/27/2024 12:00:00 AM

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ADAS Hardware Components Technical Expert
  • Ford
  • Dearborn, MI
  • Job Description In this position... We are the movers of the world and the makers of the future. We get up every day, ro...
  • 3/27/2024 12:00:00 AM

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System Integration Technical Expert
  • Traxen
  • Plymouth, MI
  • We are a Plymouth, Michigan based startup, developing cutting-edge technologies for Driver Assistance and Automated Driv...
  • 3/25/2024 12:00:00 AM

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Technical Expert
  • Kelly Science, Engineering, Technology & Telecom
  • Hauppauge, NY
  • Quality / Reliability Engineer -- Hauppauge, NY - 6 to 12 Month Contract Assignment No C2C or Sponsorship available at t...
  • 3/25/2024 12:00:00 AM

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Manufacturing Technical Expert (Stamping)
  • American Honda Motor Co Inc
  • Marysville, OH
  • At Honda, The Power of Dreams drives us to create intelligent products that enhance mobility and increase the joy in peo...
  • 3/25/2024 12:00:00 AM

Mississippi is bordered to the north by Tennessee, to the east by Alabama, to the south by Louisiana and a narrow coast on the Gulf of Mexico; and to the west, across the Mississippi River, by Louisiana and Arkansas. In addition to its namesake, major rivers in Mississippi include the Big Black River, the Pearl River, the Yazoo River, the Pascagoula River, and the Tombigbee River. Major lakes include Ross Barnett Reservoir, Arkabutla Lake, Sardis Lake, and Grenada Lake with the largest lake being Sardis Lake. Mississippi is entirely composed of lowlands, the highest point being Woodall Mountai...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Technician jobs
$55,974 to $78,104

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
Utilization Review Technician in Fairbanks, AK
Current National Pharmacy Technician Certification (PTCB, ExCPT or NCCT) required.
February 03, 2020
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