Utilization Review Technician jobs in New Hampshire

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 Specialist
  • PMC Medical Group
  • Somersworth, NH FULL_TIME
  • PMC Medical Group, a well-established independently owned multi-disciplinary practice, is seeking a full-time Utilization Review Specialist.

    Summary: Provide comprehensive assessment, planning, implementation, and evaluation of individual patient care needs. Coordinate and promote continuity of care and cost effectiveness through the functions of case management, utilization review and authorization management.

    Essential Functions:

    • Communicate with providers regularly throughout patient care and develop an effective working relationship
    • Maintain current knowledge of insurance medical policies guidelines to ensure providers remain in compliance, documentation meets criteria, and patients requiring services meet required guidelines
    • Ensure the medical practice is complying with state, federal and company based regulations and policies
    • Ensure that patient procedures are appropriate, necessary, and carried out within the established timeframe
    • Review insurance criteria to ensure patients and providers are not exceeding insurance limits
    • Assist providers to maintain appropriate cost, case, and desired patient outcomes
    • Collaborate with clinical staff in the development and execution of the plan of care and achievement of goals
    • Verify patient insurance benefits
    • Obtain authorization from insurance carriers for medically necessary procedures
    • Promote effective and efficient utilization of clinical resources
    • Mobilize resources to achieve expected goal to assist in achieving desired clinical outcomes within the desired timeframe
    • Initiate and present “denial letters” as appropriate
    • Serve as a patient advocate. Enhance a collaborative relationship to maximize the patient’s and family’s ability to make informed decisions. Explain to patient any out of pocket costs for procedures or services.

    Education/Experience Requirements

    • High School diploma or equivalent
    • 1-2 years prior medical office experience
    • Effective communication skills, both verbal and written; strong computer and typing skills; comfortable with web-based insurance portals; customer service; familiarity with Windows based programs; familiarity with office equipment; time management skills; multi-tasking skills; ability to handle difficult situations and work under pressure; ability to collaborate and communicate within all levels of the organization.
     

    Pay dependent upon on education and past experience.

    As a team member at PMC Medical Group, you’ll enjoy:

    • 9 Paid Holidays per year
    • Accrued PTO
    • Medical Benefits via an Individual Coverage Health Reimbursement Account (ICHRA)
    • Dental
    • Life Insurance & Disability
    • 401k
     

    Job Type: Full-time

    Work Location: Hybrid remote in Somersworth, NH 03878


  • 22 Days Ago

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Director Utilization Review
  • Clinical Management Consultants
  • Manchester, NH FULL_TIME
  • A leading acute care hospital located in central New Hampshire is now seeking an experienced Director Case Management to join their award-winning healthcare team. This regional leading acute care hosp...
  • 10 Days Ago

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Registered Nurse - Utilization Review Coordinator
  • Exeter Hospital
  • Exeter, NH PER_DIEM
  • Hybrid opportunity, must be local to Exeter, NH. Exeter Hospital, Core Physicians, and Rockingham VNA & Hospice, part of Beth Israel Lahey Health, proudly serve the beautiful NH seacoast region. Our p...
  • 25 Days Ago

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Automotive Technician with Berlin City Kia
  • Kia Veterans Technician Apprenticeship Program (VTAP)
  • Gorham, NH FULL_TIME
  • Kia Retailers are offering skilled and experienced military Veterans with the opportunity to begin an inspiring career as a Kia Certified Service Technician. To support this Kia Retailer initiative, K...
  • 1 Month Ago

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Utilization Management Representative II
  • Elevance Health
  • NH, NH FULL_TIME
  • Description Utilization Management Representative II Location: Remote A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers super...
  • 4 Days Ago

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COMPLIANCE REVIEW OFFICER
  • New Hampshire Hospital
  • Concord, NH FULL_TIME
  • Salary: 44,713.500-62,575.500 :USD State of New Hampshire Job Posting Department of Transportation Bureau of Policy and Administration 7 Hazen Drive, Concord, NH COMPLIANCE REVIEW OFFICER (PROGRAM SPE...
  • 1 Day 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

New Hampshire is part of the six-state New England region. It is bounded by Quebec, Canada, to the north and northwest; Maine and the Atlantic Ocean to the east; Massachusetts to the south; and Vermont to the west. New Hampshire's major regions are the Great North Woods, the White Mountains, the Lakes Region, the Seacoast, the Merrimack Valley, the Monadnock Region, and the Dartmouth-Lake Sunapee area. New Hampshire has the shortest ocean coastline of any U.S. coastal state, with a length of 18 miles (29 km), sometimes measured as only 13 miles (21 km). New Hampshire was home to the rock forma...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Technician jobs
$63,594 to $88,737

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