Top 45 Utilization review Jobs in Windham, Nh

Haverhill Pavilion - Utilization Specialist
Haverhill Behavioral Health —Haverhill, MA
- Full-time
- CPR Certification
- Nursing
- RN License
11d
RN Utilization Review - Patient & Family Services - Per Diem
Southern New Hampshire Health —Nashua, NH
- Part-time
- Nursing
- RN License
- Hospital
- Disability insurance
- Health insurance
RN Manager Utilization Review- Full Time- Days
Elliot Health System —Manchester, NH
- Full-time
- Nursing
- RN License
- Hospital
- Disability insurance
- Health insurance
7d
RN, Acute Care Case Manager - Full Time
Southern New Hampshire Health —Nashua, NH
- Full-time
- Acute care
- Nursing
- RN License
- Paid training
- Disability insurance
Licensed-Eligible Clinician for Community Based Health Center
Vinfen —Lowell, MA
- $74,780 - $78,480 a year
- Full-time
- Bilingual
- Psychiatry
- Adults
- Health savings account
- AD&D insurance
Quick Apply
Outpatient Behavioral Health Clinic Director (LICSW, LMHC, Or PsyD License)
Bridgewell —Danvers, MA
- $95,000 - $118,000 a year
- Weekends as needed
- Background check
- CPR Certification
- Public speaking
- Health insurance
- Dental insurance
Quick Apply
1d
Pharmacist
Greater Lawrence Family Health Center —Lawrence, MA
- Part-time
- Spanish
- BLS Certification
- Internal Medicine
- Tuition reimbursement
Quick Apply
Clinical Supervisor
Wayside Youth & Family Support Network —Lowell, MA
- $75,000 - $85,000 a year
- Full-time
- LMFT
- Customer service
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Registered Nurse, Home Health Program Nurse Coordinator
Greater Lawrence Family Health Center —Methuen, MA
- Nursing
- RN License
- Internal Medicine
- Tuition reimbursement
Quick Apply
Youth MCI Clinical Supervisor
Vinfen —Lowell, MA
- $96,842 a year
- Full-time
- Background check
- Clean driving record
- Management
Quick Apply
Licensed Practical Nurse
TalentBurst, Inc. —Milford, NH
- $1,320 - $1,360 a week
- Contract
- CPR Certification
- Nursing
- Computer literacy
- Health insurance
- Dental insurance
Quick Apply
1d
Inpatient Case Manager - LSW or RN
Clinical Magnet —Woburn, MA
- $45 - $53 an hour
- Part-time
- RN License
- Inpatient
- Mid-level
- Employee stock purchase plan
- Health insurance
Quick Apply
1d
Registered Nurse Care Coordinator -40hrs 8:00am - 4:30pm
Merrimack Health —Methuen, MA
- Full-time
- Nursing
- RN License
- Hospital
10d
Nurse Manager – Utilization Management (Full Time)
Beth Israel Lahey Health —Burlington, MA
- $165,000 - $215,000 a year
- Full-time
- Nursing
- RN License
- Hospital
Director, Utilization Review
Cobalt Benefits Group LLC —Exeter, NH
- $135,000 - $155,000 a year
- RN License
- 5 years
- US work authorization
- Health savings account
- AD&D insurance
Quick Apply
RN Case Manager- Care Coordination- Full Time
Elliot Health System —Manchester, NH
- Full-time
- Nursing
- Hospital
- 5 years
- Disability insurance
- Health insurance
Complex Care Nurse Manager - Per-Diem
Merrimack Health —Lawrence, MA
- $37.90 - $81.44 an hour
- Per diem
- Nursing
- RN License
- 5 years
Nurse Case Manager – Care Transitions (Part Time)
Beth Israel Lahey Health —Burlington, MA
- $38.11 - $98.23 an hour
- Part-time
- Nursing
- RN License
- Customer service
Hospital Billing Specialist (Accounts Receivable)
Tufts Medicine —Lowell, MA
- $21.53 - $26.91 an hour
- Full-time
- Word processing
- Research
- Mid-level
Director Provider Network Management
Amerihealth Caritas —Manchester, NH
- Full-time
- Hybrid work
- Office
- Driver's License
- Bachelor's degree

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utilization review jobs near windham, nh

Haverhill Pavilion - Utilization Specialist

Haverhill Behavioral Health -
Haverhill, MA

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Job Details

Full-time
11 days ago

Qualifications

CPR Certification
BLS Certification
High school diploma or GED

Full Job Description

Overview:

PURPOSE STATEMENT:

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.

Responsibilities:

ESSENTIAL FUNCTIONS:

Act as liaison between managed care organizations and the facility professional clinical staff.
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
Conduct quality reviews for medical necessity and services provided.
Facilitate peer review calls between facility and external organizations.
Initiate and complete the formal appeal process for denied admissions or continued stay.
Assist the admissions department with pre-certifications of care.
Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

OTHER FUNCTIONS:

Perform other functions and tasks as assigned.

Qualifications:

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

Required Education: High school diploma or equivalent.
Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred

LICENSES/DESIGNATIONS/CERTIFICATIONS:

Required Licensure: LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
First aid may be required based on state or facility requirements.

ADDITIONAL REGULATORY REQUIREMENTS:

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances
(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.

We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.

HVBHL

#LI-HPBH

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Refine Your Search

utilization review jobs in windham, nh

Haverhill Pavilion - Utilization Specialist

RN Utilization Review - Patient & Family Services - Per Diem

RN Manager Utilization Review- Full Time- Days

RN, Acute Care Case Manager - Full Time

Licensed-Eligible Clinician for Community Based Health Center

Outpatient Behavioral Health Clinic Director (LICSW, LMHC, Or PsyD License)

Pharmacist

Clinical Supervisor

Registered Nurse, Home Health Program Nurse Coordinator

Youth MCI Clinical Supervisor

Licensed Practical Nurse

Inpatient Case Manager - LSW or RN

Registered Nurse Care Coordinator -40hrs 8:00am - 4:30pm

Nurse Manager – Utilization Management (Full Time)

Director, Utilization Review

RN Case Manager- Care Coordination- Full Time

Complex Care Nurse Manager - Per-Diem

Nurse Case Manager – Care Transitions (Part Time)

Hospital Billing Specialist (Accounts Receivable)

Director Provider Network Management

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