Top 33 Utilization review Jobs in Memphis, Tn

Part Time Utilization Specialist
Crestwyn Behavioral Health —Germantown, TN
- Part-time
- CPR Certification
- Nursing
- RN License
Specialist-Denial I
Baptist Memorial Health Care —Memphis, TN
- RN License
- Computer literacy
- Mid-level
PRN Admissions Counselor
Crestwyn Behavioral Health —Germantown, TN
- PRN
- CPR Certification
- Nursing
- BLS Certification
Case Mgr/RN
REGIONAL ONE HEALTH —Memphis, TN
- PRN
- Nursing
- Hospital
- HIPAA
Mental Health Outpatient Program Administrator
Psychiatric Medical Care —Collierville, TN
- Up to $110,000 a year
- No weekends
- Microsoft Excel
- Psychiatry
- RN License
- Health insurance
- Dental insurance
Quick Apply
10d
Discharge Planner/RN
REGIONAL ONE HEALTH —Memphis, TN
- Full-time
- Nursing
- RN License
- HIPAA
RN-Case Manager
Baptist Memorial Health Care —Southaven, MS
- Nursing
- RN License
- Mid-level
Mobile Response Counselor
Crestwyn Behavioral Health —Germantown, TN
- Full-time
- CPR Certification
- Nursing
- BLS Certification
Hospitalist | Methodist North
Methodist Le Bonheur Healthcare —Germantown, TN
- Full-time
- Medicine
- BC/BE
- Inpatient
Quick Apply
RN-Case Manager PRN
Baptist Memorial Health Care —Memphis, TN
- PRN
- Nursing
- RN License
- Mid-level
RN-Acute Care Case Manager
Baptist Memorial Health Care —Memphis, TN
- Acute care
- Nursing
- RN License
RN-Acute Care Case Manager PRN Weekends
Baptist Memorial Health Care —Memphis, TN
- Weekends as needed
- Acute care
- Nursing
- RN License
VP, Associate Chief Medical Officer
SHELBY COUNTY HEALTH CARE CORPORATION —Memphis, TN
- Full-time
- Medicine
- Hospital
- 5 years
PRN Physical Therapist Assistant
Midtown Center for Health and Rehabilitation —Memphis, TN
- Per diem
- Computer literacy
- Physical & Rehabilitation Medicine
- English
Quick Apply
Regional Medical Director (Pediatrics)-GA/TN/AL
Zarminali Pediatrics —Memphis, TN
- Medicine
- Clinic
- Children
Quick Apply
RN - Admissions Acute
Delta Specialty Hospital —Memphis, TN
- 12 hour shift
- Acute care
- CPR Certification
- Nursing
- Health insurance
- Dental insurance
Pharmacist - Inpatient Pharmacy (Operating Room Patient Care Area Pharmacist)
Regional One Health —Memphis, TN
- Full-time
- Surgery
- Inpatient
- Mid-level
Clinical Nurse Manager
Mitchell Family Medicine and The Ark Children's Clinic —Marion, AR
- $75,000 a year
- Full-time
- Background check
- Nursing
- Vital signs
- Health insurance
- Dental insurance
Quick Apply
2d
Family Nurse Practitioner / Physician Assistant
Davis Family Medicine —Hernando, MS
- Part-time
- Urgent Care
- Primary Care
- Mid-level
- Health insurance
- Paid time off
Quick Apply
Case Management II | La Bonheur | PRN Days
Methodist Le Bonheur Healthcare —Memphis, TN
- Part-time
- Nursing
- RN License
- Hospital
Quick Apply

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utilization review jobs near memphis, tn

Part Time Utilization Specialist

Crestwyn Behavioral Health -
Germantown, TN

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Job Details

Part-time

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:

Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I 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.

Apply Now

Refine Your Search

utilization review jobs in memphis, tn

Part Time Utilization Specialist

Specialist-Denial I

PRN Admissions Counselor

Case Mgr/RN

Mental Health Outpatient Program Administrator

Discharge Planner/RN

RN-Case Manager

Mobile Response Counselor

Hospitalist | Methodist North

RN-Case Manager PRN

RN-Acute Care Case Manager

RN-Acute Care Case Manager PRN Weekends

VP, Associate Chief Medical Officer

PRN Physical Therapist Assistant

Regional Medical Director (Pediatrics)-GA/TN/AL

RN - Admissions Acute

Pharmacist - Inpatient Pharmacy (Operating Room Patient Care Area Pharmacist)

Clinical Nurse Manager

Family Nurse Practitioner / Physician Assistant

Case Management II | La Bonheur | PRN Days

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