Utilization Review Technician jobs in the United States

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 - Non Exempt
  • Utilization Review - 630
  • Baltimore, MD FULL_TIME
  • Utilization Review - 630
    As Needed
    Day 8 Hour Shifts (8:30 am-5:00 pm)
    0
    Req# 43127

    JOB DESCRIPTION SUMMARY:

    Under general supervision, utilize clinical knowledge and critical thinking skills to provide oversight of appropriate admission status and utilization of hospital resources facilitating quality, cost-effective patient outcomes. Works collaboratively with interdisciplinary staff internal and external to the organization ensuring maximum reimbursement for the hospital through the utilization review process. Active participation and attendance in daily multidisciplinary rounds. Responsible for analyzing clinical information and performing timely concurrent and retrospective reviews using InterQual screening software to identify appropriate medical necessity, length of stay, and level of care based upon evidence based clinical guidelines.

    Education

    Bachelor of Science in Nursing (BSN) OR Advanced Practitioner licensure

    Experience

    Seven (7) years diversified, progressive experience in acute care and/or other settings within the continuum required.

    Two (2) years of Case Management which includes Utilization Review, Discharge Planning and working with Re-Admission Initiatives preferred.

    Knowledge, Skills and Abilities

    • Broad knowledge of medical treatment practices
    • Knowledge of healthcare regulatory agency standards for health care organizations.
    • Ability to operate independently and to balance multiple priorities.
    • Strong interpersonal, and influencing skills necessary to interact effectively with physicians, payers, regulatory agencies, staff, and other health professionals
    • Knowledge of InterQual and/or Milliman criteria
    • Skill in using computer software programs
    • Advanced skill in oral and written communication
    • Advanced skill in critical thinking
    • Ability to resolve complex problems
    • Ability to remain calm under pressure and intense time constraints
    • Ability to assess discharge needs for patients

    Licensures, Certifications

    • Current state of Maryland Registered Nurse, Physician Assistant, or Nurse Practitioner license
    • Certification in Utilization Management and/or Care Management highly desired.

    Physical Requirements

    • Ability to sit, stand, stoop, and bend.

    Working Conditions

    • Primarily in an office environment, evaluating electronic medical records and performing electronic documentation and communication 70% of time. Remainder of time working with interdisciplinary staff,

    Conditions of Employment

    • Maintain current licensure and certification
    GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

     

  • 19 Days Ago

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Case Management Specialist - Utilization Review
  • Utilization Review in Owensboro, KY - Owensboro
  • Owensboro, KY FULL_TIME
  • Summary Job Summary Facilitates cost-effective, quality patient outcomes by determining the appropriate level of care and providing guidance, education, and support to assigned patients. Job Responsib...
  • 8 Days Ago

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RN Case Manager - Utilization Review (FT Days)
  • Utilization Review (FT Days) - Grady Health System Careers
  • United States, GA FULL_TIME
  • SUMMARY The Nurse Case Manager collaborates with other members of the case management and health care teams, utilizes professional nursing skills to: assist the patient in achieving optimal health; as...
  • 24 Days Ago

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Utilization Review Technician III
  • Prime Healthcare Management Inc
  • Ontario, CA FULL_TIME
  • Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providi...
  • 23 Days Ago

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Utilization Management/Utilization Review
  • Windmill Wellness Ranch LLC
  • Canyon, TX FULL_TIME
  • Windmill Wellness opened the Ranch in May of 2017. We are nestled in the Texas Hill Country and are sitting on 76 acres. The mission of Windmill Wellness Ranch Is to improve the physical, spiritual an...
  • 3 Days Ago

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Utilization Review Nurse - Utilization Management
  • METROHEALTH MEDICAL CENTER
  • Cleveland, OH FULL_TIME
  • Location: METROHEALTH MEDICAL CENTER Biweekly Hours: 64.00 Shift: variable start time, day shift The MetroHealth System is redefining health care by going beyond medical treatment to improve the found...
  • 22 Days Ago

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App. Technical Specialist Senior (Onsite)
  • Serigor Inc.
  • Washington, DC
  • Job Title: App. Technical Specialist Senior (Onsite) Location: Washington, DC Duration: 12 Months+ Short Description: 11...
  • 3/28/2024 12:00:00 AM

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SOC Analyst/Security Engineer Technical Specialist
  • Cyber Management International Corp
  • Sterling, VA
  • Job Description Job Description Job Title: Sr. SOC Analyst/Security Engineer Technical Specialist Location: Sterling, VA...
  • 3/27/2024 12:00:00 AM

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Enterprise Operations Center Technical Specialist
  • Dunhill Professional Search & Government Solutions
  • Ashburn, VA
  • This position is to support CBP! Must be able to obtain a public trust for the position. Location (Ashburn, VA) : Nights...
  • 3/26/2024 12:00:00 AM

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Embodied Carbon Technical Expert (Remote) Life Cycle Assessment
  • ICF International, Inc.
  • Reston, VA
  • LOB/Portfolio: Energy International Development/Energy Efficiency Location: US/Remote Are you an expert on the topic of ...
  • 3/26/2024 12:00:00 AM

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Advanced Manufacturing Technical Specialist
  • Guidehouse
  • Mc Lean, VA
  • Job Family: Technology Consulting Travel Required: Up to 25% Clearance Required: Active Secret What You Will Do: Join a ...
  • 3/26/2024 12:00:00 AM

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Systems Architect Senior Technical Specialist
  • Marathon TS
  • Reston, VA
  • MarathonTS is seeking a Systems Architect Senior Technical Specialist to support our Federal customer in the Washington,...
  • 3/26/2024 12:00:00 AM

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Veterinary Assistant/Tech/Expert in-home pet care (part-time)
  • ALEXANDRIA PET CARE INC
  • Alexandria, VA
  • Job Description Job Description APPLY FOR A PHONE INTERVIEW: 5-minute application at our website: https://alexandriapetc...
  • 3/25/2024 12:00:00 AM

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Compensation Project Manager and Technical Specialist
  • PRM Consulting Group, Inc.
  • Washington, DC
  • PRM Consulting Group, Inc. is seeking a highly skilled and detail-oriented individual to join our team as a Compensation...
  • 3/25/2024 12:00:00 AM

Income Estimation for Utilization Review Technician jobs
$62,766 to $87,580