Top 43 Utilization review Jobs in Fairview Heights Il

Market Appeals Specialist
UHS - Nashville Regional Office —Illinois
- $69,000 - $89,000 a year
- Full-time
- Remote
- Microsoft Excel
- RN License
- Writing skills
- Health insurance
- Dental insurance
Quick Apply
10d
RN Utilization Review Case Manager
Gateway Regional Medical Center —Granite City, IL
- $32 - $48 an hour
- Full-time
- Nursing
- RN License
- Hospital
- Paid holidays
- Health insurance
Quick Apply
Manager Utilization Review
KVC Health Systems —St. Louis, MO
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Writing skills
Quick Apply
Case Manager
SSM Health Rehabilitation Hospital —St. Louis, MO
- $77,000 - $105,000 a year
- 8 hour shift
- RN License
- Hospital
- Inpatient
- Dental insurance
- Paid time off
Quick Apply
RN Care Manager II-IPCM/FT/Mercy Hospital STL
Mercy —St. Louis, MO
- Full-time
- CPR Certification
- Nursing
- RN License
- Health insurance
- Dental insurance
UR Coordinator
Arch Vista —St. Louis, MO
- $15 - $22 an hour
- Psychiatry
- Adults
- HIPAA
- Paid holidays
- Disability insurance
Quick Apply
2d
Hospice Clinical Team Manager (RN Required)
VITAS Healthcare —St. Louis, MO
- Full-time
- Nursing
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
MDS Coordinator RN $5,000 Sign On Bonus
EverVella of Swansea —Swansea, IL
- $90,000 - $100,000 a year
- Full-time
- Nursing
- Skilled nursing facility
- RN License
Quick Apply
5d
MDS Coordinator (RN) *Sign-On Bonus!*
St. Sophia Health & Rehabilitation Center —Florissant, MO
- Full-time
- CPR Certification
- Nursing
- Skilled nursing facility
- Dental insurance
- 401(k)
Quick Apply
RN Field Case Manager- Chicago, IL
OpTech LLC —Illinois
- $80,000 - $90,000 a year
- No weekends
- Nursing
- Microsoft Outlook
- RN License
- Mileage reimbursement
- Paid holidays
Quick Apply
8d
Licensed Social Worker -Case Manager
Gateway Regional Medical Center —Granite City, IL
- $25.71 - $41.65 an hour
- Full-time
- Master of Social Work
- Hospital
- Licensed Clinical Social Worker
- Paid holidays
- Health insurance
Quick Apply
Case Manager - Hospital Social Work
SSM Health Rehabilitation Hospital —St. Louis, MO
- $77,000 - $105,000 a year
- 8 hour shift
- RN License
- Hospital
- Inpatient
- Dental insurance
- Paid time off
Quick Apply
RN Case Manager - Christian Hospital, Emergency Department
BJC HealthCare —St. Louis, MO
- $69,888 - $106,912 a year
- Full-time
- Acute care
- Nursing
- Mid-level
- Disability insurance
- Health insurance
9d
RN Case Manager (Emergency Room) - Barnes-Jewish Hospital
BJC HealthCare —St. Louis, MO
- $69,888 - $106,912 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Disability insurance
- Health insurance
3d
RN Case Manager - PRN, Mindful Living Institute at Christian Hospital
BJC HealthCare —St. Louis, MO
- $33.60 - $51.40 an hour
- No weekends
- Nursing
- RN License
- Hospital
- Disability insurance
- Health insurance
RN Nurse Navigator - Mercy Clinic Orthopedics
Mercy —St. Louis, MO
- Full-time
- Nursing
- Surgery
- RN License
- Paid parental leave
- Health insurance
9d
Hospitalist Medical Director - Missouri (work from home)
Optum —St. Louis, MO
- $238,000 - $357,500 a year
- Full-time
- Remote
- Medicine
- 5 years
- Pass drug screening
- Health insurance
- 401(k)
Quick Apply
10d
Senior Clinical Solutions Specialist
Medline Industries —St. Louis, MO
- $92,000 - $138,000 a year
- Full-time
- Microsoft Excel
- RN License
- Hospital
- Health insurance
- 401(k)
MDS Coordinator
Evercare at University —Edwardsville, IL
- $80,000 - $90,000 a year
- Full-time
- Skilled nursing facility
- RN License
- Physical & Rehabilitation Medicine
Quick Apply
1d
Part Time Patient Services Representative
BioTAB Healthcare —St. Louis, MO
- $17.50 an hour
- Part-time
- Background check
- HIPAA
- Research
Quick Apply

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Market Appeals Specialist

UHS - Nashville Regional Office
Illinois

Quick Apply

Job Details

Full-time
$69,000 - $89,000 a year
10 days ago

Benefits

Health insurance
Dental insurance
401(k)
Tuition reimbursement
Paid time off
Vision insurance
401(k) matching

Qualifications

Appeals
Microsoft Excel
Writing skills
LPC
Inventory management software
Master's degree
Database management
Case appeal in utilization management
Bachelor's degree
Utilization management
Resource utilization in healthcare
Microsoft Teams
Productivity software
Clinical documentation standards
Insurance claims appeal handling
LCSW-C

Full Job Description

BH Shared Services (a UHS company) is currently seeking an experienced Market Appeals Specialist to join our established team in the Central Appeals Office.

POSITION SUMMARY: This position supports utilization management and shared services within the behavioral health division. This role oversees and completes all standard appeals within a designated market, including both Cerner and non-Cerner facilities.
A successful candidate must have knowledge of utilization management operations, including experience with appeal letters and payer engagement. The ability to apply clinical acumen in a behavioral health setting both verbally and in writing is essential to this role. *This is a fully remote position.

RESPONSIBILITIES:

Complete all standard appeals timely and manage appeal inventory through ongoing tracking and monitoring.
Act as a liaison with local facilities and payers to ensure timely appeal processing including appropriate follow-up with payers for facility reimbursement.
Participate in local facility UM team meetings to support the standard appeal process.
Provide feedback to providers and UM team on opportunities impacting facility recoveries (e.g., documentation)
Performs other duties as assigned/required by this position

This opportunity provides the following:

UHS offers a challenging and rewarding work environment
Growth and development opportunities within UHS and its subsidiaries
Competitive Compensation
Excellent Medical, Dental, Vision and Prescription Drug Plan.
401k plan with company match
Generous Paid Time Off

REQUIREMENTS:

Bachelor's degree required, Master's preferred
RN License or Master's level clinician required,Licenusre preferred
3-5 years related experience required, 5-8 preferred
Knowledge of utilization management operations, including experience with appeal letters and payer engagement.
Proficient in Excel, Microsoft Office/Teams, Word, and database inventory management.
Knowledge of payer requirements for reimbursement across all levels of care and behavioral health business office operations.
Strong oral communication skills to represent patient progress and treatment in behavioral health.
Understanding of medical necessity criteria application for all levels of care.
Ability to apply clinical acumen in behavioral health to written correspondence.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

Avoid and Report Recruitment Scams

We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information.

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

Pay: $69,000.00 - $89,000.00 per year

Benefits:

401(k)
Dental insurance
Health insurance
Paid time off
Tuition reimbursement
Vision insurance

Education:

Master's (Preferred)

License/Certification:

LCSW-C (Preferred)
LPC (Preferred)

Work Location: Remote

Quick Apply

Refine Your Search

utilization review jobs in fairview heights il

Market Appeals Specialist

RN Utilization Review Case Manager

Manager Utilization Review

Case Manager

RN Care Manager II-IPCM/FT/Mercy Hospital STL

UR Coordinator

Hospice Clinical Team Manager (RN Required)

MDS Coordinator RN $5,000 Sign On Bonus

MDS Coordinator (RN) Sign-On Bonus!

RN Field Case Manager- Chicago, IL

Licensed Social Worker -Case Manager

Case Manager - Hospital Social Work

RN Case Manager - Christian Hospital, Emergency Department

RN Case Manager (Emergency Room) - Barnes-Jewish Hospital

RN Case Manager - PRN, Mindful Living Institute at Christian Hospital

RN Nurse Navigator - Mercy Clinic Orthopedics

Hospitalist Medical Director - Missouri (work from home)

Senior Clinical Solutions Specialist

MDS Coordinator

Part Time Patient Services Representative

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