Utilization Review Coordinator jobs in Chandler, AZ

Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)

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Utilization Review Nurse
  • Oscar Health
  • Tempe, AZ FULL_TIME
  • Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Clinical Review team.

    Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

    About the role

    As the Utilization Nurse you will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will also make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

    You will report to the Utilization Review Supervisor.

    This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

    The base pay for this role is: $72,800 - $95,555 per year. You are also eligible for employee benefits, monthly vacation accrual at a rate of 10 days per year.

    Responsibilities

    • Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
    • Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
    • Meet required decision-making SLAs
    • Refer members for further care engagement when needed
    • Compliance with all applicable laws and regulations
    • Other duties as assigned

    Qualifications

    • Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
    • Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Diploma Program in Practical Nursing of Accredited School of Nursing
    • Ability to obtain additional state licenses to meet business needs
    • 1 year of utilization review experience in a managed care setting
    • 2 years of clinical experience (including at least 1 year clinical practice in an acute care setting, i.e., ER or hospital)

    Bonus Points

    • BSN
    • Previous experience conducting concurrent or inpatient reviews for a managed care plan

    This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

    At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care - an experience made whole by our unique backgrounds and perspectives..

    Pay Transparency:

    Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience.

    Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

    Reasonable Accommodation:

    Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

  • 21 Days Ago

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RN Utilization Review Case Manager
  • Actalent
  • Tempe, AZ OTHER
  • Hiring a RN UR Case manager for a full remote opportunity with hospital!! MUST HAVE Current CA RN Licensure, InterQual experience, EPIC Experience and at least 2 years of experience! Amazing team!M-F ...
  • 6 Days Ago

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Utilization Management Manager Regulatory Operations
  • Oscar Health
  • Tempe, AZ FULL_TIME
  • Hi, we're Oscar. We're hiring a UM Manager Regulatory Operations to join our Utilization Management Optimization team. Oscar is the first health insurance company built around a full stack technology ...
  • Just Posted

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Utilization Reviews Appeals Registered Nurse
  • Oscar Health
  • Tempe, AZ FULL_TIME
  • Hi, we're Oscar. We're hiring a Utilization Review Appeals RN to join our Utilization Review team. About the role The appeals & claims UR nurse is responsible for the investigation and review of clini...
  • 1 Month Ago

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Paid Product Tester
  • Product Review Jobs
  • FORT APACHE, AZ FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • 3 Days Ago

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Paid Product Tester
  • Product Review Jobs
  • NUTRIOSO, AZ FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • 6 Days Ago

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0 Utilization Review Coordinator jobs found in Chandler, AZ area

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Civil CADD Designer
  • VES Professional Services, LLC
  • Scottsdale, AZ
  • Job Description Job Description Job Responsibilities: Civil Engineering Design and preparation of Construction Drawings ...
  • 3/28/2024 12:00:00 AM

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Assistant Store Leader
  • Fry's Food and Drug
  • Glendale, AZ
  • JOB DESCRIPTION Learn the operations of all departments and the duties of store management; share responsibility for sto...
  • 3/27/2024 12:00:00 AM

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Assistant Store Leader
  • Fry's Food and Drug
  • Maricopa, AZ
  • JOB DESCRIPTION Learn the operations of all departments and the duties of store management; share responsibility for sto...
  • 3/27/2024 12:00:00 AM

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Assistant Store Leader
  • Fry's Food and Drug
  • Casa Grande, AZ
  • JOB DESCRIPTION Learn the operations of all departments and the duties of store management; share responsibility for sto...
  • 3/27/2024 12:00:00 AM

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Utilities Supervisor (Night Shift)
  • Nestle Operational Services Worldwide SA
  • Waddell, AZ
  • Foods people love. Brands people trust. And a career that nourishes your future like no other. If you're driven by the p...
  • 3/27/2024 12:00:00 AM

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Healthcare Coordinator
  • Pacific Dental Services
  • Chandler, AZ
  • Description: Now is the time to join Chandler Modern Dentistry and Orthodontics. You will have opportunities to learn ne...
  • 3/27/2024 12:00:00 AM

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Reservation Associate (REMOTE)
  • Feyer&Associates
  • Chandler, AZ
  • We are seeking detail-oriented and dedicated Reservation Associates to join our team. As a Reservation Associate, you wi...
  • 3/25/2024 12:00:00 AM

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Scheduling Coordinator - Chandler, AZ
  • Optum
  • Chandler, AZ
  • $2000 Sign-On Bonus for External Candidates Optum is a global organization that delivers care, aided by technology to he...
  • 3/25/2024 12:00:00 AM

Chandler is a city in Maricopa County, Arizona, United States, and a prominent suburb of the Phoenix, Arizona, Metropolitan Statistical Area (MSA). It is bordered to the north and west by Tempe, to the north by Mesa, to the west by Phoenix, to the south by the Gila River Indian Community, and to the east by Gilbert. As of 2017, the population was estimated at 253,458 according to the United States Census Bureau. According to the United States Census Bureau, Chandler has a total area of 58.0 square miles (150 km2), of which 57.9 square miles (150 km2) of it is land and 0.1 square miles (0.26 km...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Coordinator jobs
$79,702 to $98,723
Chandler, Arizona area prices
were up 2.2% from a year ago

Utilization Review Coordinator in Fort Lauderdale, FL
Some review coordinator positions require that professionals have training and experience within a more specific field.
January 10, 2020
Utilization Review Coordinator in Asheville, NC
Schick Shadel Hospital is seeking a part-time (20 hours per week) Utilization Review Coordinator (UR Coordinator) to help oversee and perform the process of utilization review to ensure appropriate reimbursement by third party payers.
January 04, 2020
Utilization Review Coordinator in Jacksonville, FL
Excellent benefits, pay, small on-site employee gym, wonderful co-workers and managersFull Review.
January 04, 2020