Top 699 Utilization Reviewer Jobs

Utilization Management Representative II
Elevance Health —San Antonio, TX
- 8 hour shift
- Mid-level
- High school diploma or GED
- Analysis skills
- Employee stock purchase plan
- Paid holidays
9d
Utilization Management Clinical Reviewer
tango —Remote
- Weekends as needed
- Nursing
- LVN
- RN License
Quick Apply
12h
Utilization Reviewer (FT)
Rehabilitation Hospital of Indiana —Indianapolis, IN
- Full-time
- Hospital
- Mid-level
- 3 years
- Tuition reimbursement
- 401(k) matching
Quick Apply
Physician Reviewer - Utilization Management (Part Time)
Oscar Health —New York, NY
- $130 - $145 an hour
- Part-time
- Remote
- Medicine
- BC/BE
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
3d
Utilization Review Specialist
We Level Up —Pompano Beach, FL
- $50,000 - $90,000 a year
- Full-time
- Remote
- 18 years or older
- CPR Certification
- HIPAA
Quick Apply
Utilization Management Clinical Reviewer
CuraFi —Remote
- $140,000 - $160,000 a year
- Full-time
- RN License
- Senior level
- Communication skills
- Health insurance
- Dental insurance
Quick Apply
8d
Endocrinologist - Independent Reviewer for Disability Appeals
Emperion —Remote
- $100 - $1,000 an hour
- Part-time
- Remote
- Mid-level
- 3 years
- Communication skills
Quick Apply
Physician Reviewer - Physical Medicine and Rehabilitation (Utilization Review)
Dane Street, LLC —New York, NY
- Remote
- Physical & Rehabilitation Medicine
- Mid-level
Quick Apply
Utilization Reviewer
Element Medical Billing —Port Saint Lucie, FL
- $45,000 - $60,000 a year
- Full-time
- Anatomy knowledge
- HIPAA
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Initial Clinical Reviewer
Enlyte —Remote
- $59,000 - $73,000 a year
- Full-time
- Remote
- Clinic experience
- Mid-level
- Analysis skills
- Health savings account
- AD&D insurance
10d
Remote Home Health RN – Medical Claims Reviewer
Broadway Ventures —Remote
- $60,000 - $63,000 a year
- Full-time
- Remote
- Nursing
- RN License
- Customer service
Quick Apply
Utilization Physician Reviewer
BayCare —Tampa, FL
- PRN
- Acute care
- Medicine
- Hospital
Physician Reviewer - Orthopedic Spine (Utilization Review)
Dane Street, LLC —Texas
- Remote
- Surgery
- Senior level
Quick Apply
Utilization Management Physician Reviewer (TX Licensed)
Clearlink Partners —Remote
- $100 - $150 an hour
- Monday to Friday
- Medicine
- 7 years
- Writing skills
Quick Apply
Utilization Management Physician Reviewer (PA or NJ Licensed)
Clearlink Partners —Remote
- $100 - $150 an hour
- Medicine
- 7 years
- Writing skills
Quick Apply
ECM Enrollment Representative - Remote
Medzed LLC —San Antonio, TX
- $20 an hour
- Full-time
- Remote
- Spanish
- HIPAA
- English
Quick Apply
Diagnostic Radiology- Medical Record Reviewer
Dane Street, LLC —Minneapolis, MN
- Remote
- BC/BE
- Senior level
- Radiology
Quick Apply
Utilization Management Nurse
Applied Underwriters —Omaha, NE
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Paid training
- Paid holidays
Quick Apply
Geotechnical Department Manager I
Terracon —Tulsa, OK
- Management
- 5 years
- Master's degree
BCBA Clinical Director
GBE Alliance —Hopkinsville, KY
- Full-time
- Background check
- 3 years
- Master's degree
- Paid holidays
- Dental insurance
Quick Apply

I want to receive the latest job alert for Utilization Reviewer

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

Utilization Reviewer jobs near

Utilization Review Nurse jobs in Remote

Utilization Review Nurse jobs in Indianapolis, IN

Utilization Review Nurse jobs in Omaha, NE

Utilization Review Nurse jobs in Port Saint Lucie, FL

Utilization Review Nurse jobs in Tampa, FL

Utilization Review Nurse jobs in New York, NY

Utilization Review Nurse jobs in Pompano Beach, FL

Endocrinologist jobs in Remote

Clinical Lead Nurse jobs in San Francisco, CA

Registered Nurse Home Health jobs in Remote

Utility Manager jobs in San Antonio, TX

Enrollment Eligibility Representative jobs in San Antonio, TX

Document Review jobs in Charlotte, NC

Utilization Review Nurse jobs in Arlington, VA

Utilization Review Coordinator jobs in Atlanta, GA

Utilization Review Nurse jobs in Naples, FL

Nurse Practitioner jobs in Orange County, CA

Utilization Review Nurse jobs in Cedar Park, TX

Utilization Review Nurse jobs in Ventura, CA

Utilization Review Nurse jobs in Hawaii

Utilization Management Representative II

Elevance Health -
San Antonio, TX

Apply Now

Job Details

Full-time
9 days ago

Benefits

Employee stock purchase plan
Paid holidays
Disability insurance
Health insurance
Dental insurance
Paid time off
Vision insurance
401(k) matching
Life insurance

Qualifications

Customer communication
Medical terminology

Full Job Description

Utilization Management Representative II

Location: This role requires associates to work from the posted locations full-time, enabling consistent face-to-face collaboration, teamwork, and direct engagement. This policy promotes an environment built on in-person interaction, communication, and immediate support. This position will be based at the following location: 4751 Hamilton Wolf Rd, Ste 101, San Antonio - TX.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Schedule: This position will work an 8-hour shift, Monday through Friday. Candidate should have availability from 8:00 am to 6:00 pm (CDT). Additional hours, including weekends or holidays, may be required based on operational needs.

Be Part of an Extraordinary Team

BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies. BioPlus offer consumers and providers an unparalleled level of service that's easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer's treatment journey.

The Utilization Management Representative II is responsible for managing incoming calls, including triage, opening of cases and authorizing sessions.

How You Will Make an Impact

Primary duties may include, but are not limited to:

Managing incoming calls or incoming post services claims work.
Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
Obtains intake (demographic) information from caller.
Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given.
Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care.
Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization.
Verifies benefits and/or eligibility information.
May act as liaison between Medical Management and internal departments.
Responds to telephone and written inquiries from clients, providers and in-house departments.
Conducts clinical screening process.

Minimum Requirements:

Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

Knowledge of health plans, including familiarity with prior authorization and precertification process; knowledge of contracts and strong knowledge of managed benefit programs strongly preferred.
Previous experience of prior -authorization management is strongly preferred.
Prior experience working in a high-volume environment is preferred.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Certain contracts require a Master's degree.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act

Apply Now

Refine Your Search

Utilization Reviewer jobs

Utilization Management Representative II

Utilization Management Clinical Reviewer

Utilization Reviewer (FT)

Physician Reviewer - Utilization Management (Part Time)

Utilization Review Specialist

Utilization Management Clinical Reviewer

Endocrinologist - Independent Reviewer for Disability Appeals

Physician Reviewer - Physical Medicine and Rehabilitation (Utilization Review)

Utilization Reviewer

Initial Clinical Reviewer

Remote Home Health RN – Medical Claims Reviewer

Utilization Physician Reviewer

Physician Reviewer - Orthopedic Spine (Utilization Review)

Utilization Management Physician Reviewer (TX Licensed)

Utilization Management Physician Reviewer (PA or NJ Licensed)

ECM Enrollment Representative - Remote

Diagnostic Radiology- Medical Record Reviewer

Utilization Management Nurse

Geotechnical Department Manager I

BCBA Clinical Director

I want to receive the latest job alert for Utilization Reviewer

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected