Utilization Review Technician jobs in Stroudsburg, 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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Utilization Review Nurse
  • St. Lukes Hospital
  • Bethlehem, PA PART_TIME
  • St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Utilization Review Nurse will be responsible for substantiating medical necessity and clinical appropriateness of services in order to achieve quality outcomes and ensure appropriate reimbursement. JOB DUTIES AND RESPONSIBILITIES: Screens selected medical records in accordance with contractual agreements and departmental policies for appropriateness of admission; performing initial, continued stay, and retrospective reviews if applicable. Submits initial reviews and updates using established criteria and communicates with payers as appropriate, using established processes. Utilize established processes with the Physician Advisors to manage second level and peer to peer reviews. Ensure patient status and levels of care are appropriate on admission and prior to discharge. Makes timely contact with payers and provides information as appropriate. Documents all utilization review outcomes and activities appropriately in the medical record. Complies with all applicable payer, state and federal regulations as well as The Joint Commission requirements regarding Care Management and Utilization Review processes. Acts as resource for and provides updates to the care management staff and care team for issues related to utilization review processes. Engages providers with concerns regarding medical necessity and appropriateness of services. Escalate concerns related to medical necessity and appropriateness of services to the Physician Advisors. Works collaboratively with the Denials Specialist and Physician Advisors to manage retrospective appeals and documents according to established policy. Works collaboratively with the business office/finance to ensure proper reimbursement. PHYSICAL AND SENSORY REQUIREMENTS: Sitting for one to two hours at a time. Standing for up to 2 hours per day, up to 10 minutes at a time. Walk on all surfaces for up to 3 hours per day, and climb stairs. Must be capable of driving a car. Fingering and handling objects frequently, uses fingers to turn pages. Frequently uses hands to write and/or type. Rarely uses hands or fingers for firm grasping or twisting/turning. Frequently uses upper extremities to lift and carry object up to 10 lbs. Rarely may be required to lift, carry, push, and/or pull objects weighing up to 75 pounds. Occasionally stoops, bends, squats, kneels and reaches above shoulder level. Must have the ability to hear as it relates to normal conversations and high and low frequencies and to see as it relates to general and peripheral vision. Must have the ability to touch as related to telephone and computer keyboard. EDUCATION: Graduate of professional nursing program. Registered Nurse with current license to practice in the State of Pennsylvania or seeking Pennsylvania licensure through reciprocity. NJ RN licensure required upon hire. Advanced degree preferred. TRAINING AND EXPERIENCE: At least 3 years of clinical experience as a registered nurse in an acute setting. Either 2 years of hospital or payor based utilization review experience preferred. Knowledge of Interqual and Milliman criteria preferred. Care Management certification preferred. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer. Founded in 1872, St. Luke’s University Health Network (SLUHN) is a fully integrated, regional, non-profit network of more than 20,000 employees providing services at 15 campuses and 300 outpatient sites. With annual net revenue of $3.5 billion, the Network’s service area includes 11 counties in two states: Lehigh, Northampton, Berks, Bucks, Carbon, Montgomery, Monroe, Schuylkill and Luzerne counties in Pennsylvania and Warren and Hunterdon counties in New Jersey. St. Luke’s hospitals operate the largest network of trauma centers in Pennsylvania, with the Bethlehem Campus being home to St. Luke’s Children’s Hospital. SLUHN is the only Lehigh Valley-based health care system to earn Medicare’s five-star ratings (the highest) for quality, efficiency and patient satisfaction. It is both a Leapfrog Group and Healthgrades Top Hospital and a Newsweek World’s Best Hospital. The Network’s flagship University Hospital has earned the 100 Top Major Teaching Hospital designation from Fortune/Merative 11 times total and eight years in a row, including in 2023 when it was identified as THE #4 TEACHING HOSPITAL IN THE COUNTRY. In 2021, St. Luke’s was identified as one of the 15 Top Health Systems nationally. SLUHN has been named a Top Workplaces 2023 by the Morning Call. In addition, St. Luke’s has been named a Top Workplace nationally, in the Philadelphia region, and in New Jersey. St. Luke’s is the ONLY healthcare institution in Pennsylvania and the third-highest ranked healthcare entity in the nation to be deemed a Top Workplace in 2023. In 2023, St. Luke’s was named one of America’s Best Employers for Women by Forbes. St. Luke’s was the only employer in the Lehigh Valley to be named to the list and was one of only two healthcare employers in Pennsylvania to receive the designation. St. Luke’s University Health Network is the top-ranked Lehigh Valley-based employer in Forbes Magazine’s ranking of employers in Pennsylvania. Learn More Here.
  • 12 Days Ago

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Utilization Review Coordinator (REMOTE)
  • Pyramid Healthcare
  • Allentown, PA FULL_TIME
  • With this position you would have the ability to work from home!! Shift: Monday-Friday 8:00 am - 4:30 pm Deliverables/Principal Results Expected: • Perform admission, continued stay and discharge revi...
  • 14 Days Ago

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Utilization Management Specialist
  • Medix
  • Bethlehem, PA FULL_TIME
  • Medix is currently hiring for an Utilization Management Specialist for a Hosptial system in Bethlehem, PA. This position is fully onsite at the hospital. The UM Specialist will assist Utilization Mana...
  • 21 Days Ago

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Quality Record Review Specialist 1st Shift
  • QuVa Pharma Inc.
  • Bloomsbury, NJ FULL_TIME
  • Our Quality Record Review Specialist plays a vital role in ensuring the highest quality and safety standards of our pharmaceutical products. Once you complete our training, your responsibilities will ...
  • Just Posted

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Engineered Wood Products Technical Plan Review/EWP Designer
  • Eastern Engineered Wood Products
  • Bethlehem, PA FULL_TIME
  • Summary This position is responsible for analyzing and evaluating floor and roof EWP placement layouts completed by peers. After review conclusion, reviewers have the responsibility to provide accurat...
  • 1 Day Ago

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Engineered Wood Products Technical Plan Review/EWP Designer
  • Eastern Engineered Wood Products
  • Bethlehem, PA FULL_TIME
  • Summary This position is responsible for analyzing and evaluating floor and roof EWP placement layouts completed by peers. After review conclusion, reviewers have the responsibility to provide accurat...
  • 1 Day Ago

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0 Utilization Review Technician jobs found in Stroudsburg, PA area

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Customer Support and Tech Specialist
  • karier.co
  • Bethlehem, PA
  • **Customer Support and Tech Specialist** American Jewish University - Los Angeles, CA 90077 Job details Job Type Full-ti...
  • 3/28/2024 12:00:00 AM

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Pharmacy Technician & Technician Trainee
  • Rite Aid
  • Palmerton, PA
  • Pharmacy TechnicianTechnician in Training Contribute to our mission to improve Health and Wellness in your community. Be...
  • 3/28/2024 12:00:00 AM

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Pharmacy Technician & Technician Trainee
  • Rite Aid
  • White Haven, PA
  • Pharmacy TechnicianTechnician in Training Contribute to our mission to improve Health and Wellness in your community. Be...
  • 3/28/2024 12:00:00 AM

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Pharmacy Technician
  • CVS Pharmacy, Inc.
  • Stroudsburg, PA
  • Health is everything. At CVS Health, we are committed to increasing patient access to care, lowering costs and improving...
  • 3/28/2024 12:00:00 AM

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Pharmacy Technician & Technician Trainee>
  • Rite Aid Corp.
  • Allentown, PA
  • Rite Aid Corp. - 1650 North Cedar Crest Blvd. [Pharmacy Tech] As a Pharmacy Technician at Rite Aid Corp., you'll: Mainta...
  • 3/28/2024 12:00:00 AM

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Molding Technician
  • Crayola
  • Easton, PA
  • Molding Technician, Off-Shift,Easton PA GENERAL SUMMARY: Troubleshoots, repairs and monitors plastic molding equipment t...
  • 3/28/2024 12:00:00 AM

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Production Technician - Vaccine
  • Sanofi
  • Swiftwater, PA
  • Production Technician - Vaccine THIS IS A SECOND SHIFT POSITION ABOUT THE ROLE: Seasonal Position to support Influenza P...
  • 3/27/2024 12:00:00 AM

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Aquatics Technician
  • Great Wolf Lodge
  • Scotrun, PA
  • Pay: $18.50 per hour At Great Wolf, the Aquatics Technician keeps the waterpark running and provides a safe and fun envi...
  • 6/6/2023 12:00:00 AM

Stroudsburg is a borough in Monroe County, Pennsylvania, United States. It is in the state's Poconos region, approximately five miles (8 km) from the Delaware Water Gap, at the confluence of the Brodhead, McMichaels and Pocono Creeks. It is in northeastern Pennsylvania. It is also the county seat of Monroe County. Stroudsburg is part of the East Stroudsburg, PA Metropolitan Statistical Area, which in turn is part of the New York combined statistical area. The population was 5,567 at the 2010 census. Stroudsburg is located at 40°59′9″N 75°11′43″W / 40.98583°N 75.19528°W / 40.98583; -75.1952...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Technician jobs
$64,389 to $89,845
Stroudsburg, 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