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Alternate job titles: Patient Care Utilization Monitoring/Review Technician

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. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). Gains exposure to some of t more...



Alternate job titles: Utilization Review Technician

The Patient Care Utilization Monitoring/Review Technician monitors patient charts and records to evaluate care concurrent with the patients treatment. Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Being a Patient Care Utilization Monitoring/Review Technician collects and complies data as required and according to applicable policies and regulations. Reviews treatment plans and status of approvals from insurers. In addition, Patient Care Utilization Monitoring/Review Technician consults with nurses and physicians as needed. Positio more...


Alternate job titles: Utilization Review Coordinator | Registered Nurse (RN) - Utilization Review

The Utilization Review Specialist monitors patient charts and records to evaluate care concurrent with the patients treatment. Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Being a Utilization Review Specialist collects and complies data as required and according to applicable policies and regulations. Reviews treatment plans and status of approvals from insurers. In addition, Utilization Review Specialist consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Reg more...


Alternate job titles: GP | Physician Family Medicine | Physician General Practitioner

There is currently no job description for Utilization Review Physician. Be the first to submit the job responsibilities for a Utilization Review Physician.



Alternate job titles: Registered Nurse (RN) - Utilization Review | Utilization Review Specialist

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. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). Contributes to moderately complex aspects of a project. Work is generally independent and collab more...


Alternate job titles: Home Care Services Quality/Utilization Manager | Home Care Services Utilization Review Manager

Ensures quality and level of care for patients are up to established standards and comply with federal, state, and local regulations. Investigates and resolves reports of inappropriate care. May require a bachelor's degree. Typically reports to a head of a unit/department. Typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. more...



Alternate job titles: Utilization Review Coordinator | Utilization Review Specialist

The Registered Nurse (RN) - Utilization Review monitors patient charts and records to evaluate care concurrent with the patients treatment. Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Being a Registered Nurse (RN) - Utilization Review collects and complies data as required and according to applicable policies and regulations. Reviews treatment plans and status of approvals from insurers. In addition, Registered Nurse (RN) - Utilization Review consults with physicians as needed. May require a bachelor's degree. Typically reports more...


Alternate job titles: Managed Care Supervisor

The Care and Utilization Review Nurse Manager oversees staff that process referrals, authorizations, billing, utilization review, and capitation for hospital services. Supervises and coordinates activities of personnel in the managed care operations department of a healthcare facility. Being a Care and Utilization Review Nurse Manager requires a bachelor's degree. Experienced in utilization review techniques and protocols. In addition, Care and Utilization Review Nurse Manager typically reports to a manager or head of a unit/department. May require Registered Nurse (RN). Makes day-to-day decis more...


Alternate job titles: Utilization Review Manager - Home Care | Home Care Services Quality/Utilization Manager

The Home Care Services Utilization Review Manager investigates and resolves reports of inappropriate care. Ensures quality and level of care for patients are up to established standards and comply with federal, state, and local regulations. Being a Home Care Services Utilization Review Manager typically reports to a head of a unit/department. May require a bachelor's degree. Working as a Home Care Services Utilization Review Manager typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in n more...



Alternate job titles: Managed Care Coordinator

The Care and Utilization Review Nurse Coordinator ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. Coordinates utilization reviews of managed care contracts using established guidelines and processes. Being a Care and Utilization Review Nurse Coordinator maintains managed care contracts and information databases and prepares reports. Communicates with physicians, discharge planners and others to process referrals, authorization for services, and capture data related to utilization. In addition, Care and Utilization Review Nurse Coord more...


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