Top 39 Utilization review Jobs in Geneva, 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
11d
MDS Coordinator
Aperion Care DeKalb —DeKalb, IL
- $85,000 - $95,000 a year
- Full-time
- Skilled nursing facility
- RN License
- Physical & Rehabilitation Medicine
Quick Apply
11d
Clinical Admission Nurse Part time Days
Northwestern Memorial Healthcare —Geneva, IL
- $38.50 - $61.60 an hour
- Part-time
- Background check
- Nursing
- RN License
- Tuition reimbursement
- 401(k) matching
Quick Apply
2d
Utilization Management Coordinator - Full Time
Riveredge Hospital —Forest Park, IL
- $30 - $46 an hour
- Full-time
- Hospital
- Mid-level
- Master's degree
Med Staff Svc Coordinator FT HYBRID
Advocate Aurora Health —Oak Brook, IL
- $25.30 - $37.95 an hour
- Full-time
- Microsoft Excel
- Hospital
- Data analysis skills
10d
Onsite Care Coordination Nurse
Humana —Naperville, IL
- $71,100 - $97,800 a year
- Full-time
- Hybrid work
- Acute care
- Spanish
- Nursing
- Paid parental leave
- Paid holidays
4d
Dental Network Maintenance and Grievance Coordinator
DELTA DENTAL OF ILLINOIS —Naperville, IL
- $24 - $28 an hour
- Full-time
- Hybrid work
- Mid-level
- Office
- 3 years
- Paid holidays
- Disability insurance
Quick Apply
Patient Access Representative III - Linden Oaks Hospital - Per Diem
Endeavor Health —Naperville, IL
- $19.89 - $28.84 an hour
- Part-time
- Acute care
- CPR Certification
- Addiction Medicine
- Free parking
- Wellness program
Ambulatory Medication Access Coordinator – Pharmacy Tech, Prior Authorization and Pharmacy Call Center – Burr Ridge
UChicago Medicine —Burr Ridge, IL
- Full-time
- Hybrid work
- Customer service
- Word processing
- Computer literacy
- Prescription drug insurance
11d
RN Patient Placement - HUB- Per Diem
Endeavor Health —Arlington Heights, IL
- $43.69 - $67.72 an hour
- 8 hour shift
- Acute care
- Nursing
- RN License
- Free parking
- Wellness program
RN Care Manager
Advocate Aurora Health —Downers Grove, IL
- $38.20 - $57.30 an hour
- Full-time
- Nursing
- RN License
- Hospital
Patient Access Representative III - Linden Oaks Hospital/Behavioral Health - Evening Shift
Endeavor Health —Naperville, IL
- $19.89 - $28.84 an hour
- Full-time
- Addiction Medicine
- HIPAA
- Inpatient
- Free parking
- Wellness program
Registered Nurse (RN) –Patient Command Center
Advocate Aurora Health —Oakbrook Terrace, IL
- $38.20 - $57.30 an hour
- Full-time
- Acute care
- CPR Certification
- Nursing
Case Manager Care Coordination Full Time Days
Northwestern Memorial Healthcare —Winfield, IL
- $40.50 - $64.80 an hour
- Full-time
- Bilingual
- Background check
- Nursing
- Tuition reimbursement
- 401(k) matching
Quick Apply
Patient Care Manager - Floater (RN)
VITAS Healthcare —Lombard, IL
- $0.70 per mile
- Full-time
- Nursing
- RN License
- Mid-level
- Travel reimbursement
- Disability insurance
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
9d
Clinical Admission Nurse Full time Nights
Northwestern Memorial Healthcare —Geneva, IL
- $38.50 - $61.60 an hour
- Full-time
- Background check
- Nursing
- RN License
- Tuition reimbursement
- 401(k) matching
Quick Apply
2d
Outpatient Psychotherapist - LCSW or LCPC
Advocate Aurora Health —Downers Grove, IL
- $35.50 - $53.25 an hour
- Full-time
- Licensed Clinical Social Worker
- Mid-level
- Outpatient experience
Chief Medical Officer, Health Plan (Based in IL)
Molina Healthcare —Downers Grove, IL
- $246,251.34 - $480,190.11 a year
- Full-time
- Medicine
- 7 years
- Office
- Health insurance
Administrator Home Health
Elara Caring —Huntley, IL
- $120,000 - $150,000 a year
- Full-time
- Nursing
- RN License
- Office
- Mileage reimbursement
- Paid holidays
13d

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Market Appeals Specialist

UHS - Nashville Regional Office
Illinois

Quick Apply

Job Details

Full-time
$69,000 - $89,000 a year
11 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 geneva, il

Market Appeals Specialist

MDS Coordinator

Clinical Admission Nurse Part time Days

Utilization Management Coordinator - Full Time

Med Staff Svc Coordinator FT HYBRID

Onsite Care Coordination Nurse

Dental Network Maintenance and Grievance Coordinator

Patient Access Representative III - Linden Oaks Hospital - Per Diem

Ambulatory Medication Access Coordinator – Pharmacy Tech, Prior Authorization and Pharmacy Call Center – Burr Ridge

RN Patient Placement - HUB- Per Diem

RN Care Manager

Patient Access Representative III - Linden Oaks Hospital/Behavioral Health - Evening Shift

Registered Nurse (RN) –Patient Command Center

Case Manager Care Coordination Full Time Days

Patient Care Manager - Floater (RN)

RN Field Case Manager- Chicago, IL

Clinical Admission Nurse Full time Nights

Outpatient Psychotherapist - LCSW or LCPC

Chief Medical Officer, Health Plan (Based in IL)

Administrator Home Health

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