Utilization Review Manager - Home Care jobs in Scranton, PA

Utilization Review Manager - Home Care 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. Being a Utilization Review Manager - Home Care may require a bachelor's degree. Typically reports to a head of a unit/department. To be a Utilization Review Manager - Home Care 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. (Copyright 2024 Salary.com)

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Utilization Review Specialist
  • Moriah Health
  • Kingston, PA FULL_TIME
  • SUMMARY: The UR Specialist is responsible for using their clinical knowledge and/or nursing experience, the review of preauthorization and concurrent review requests for all levels of care. Must collaborate with clinical and admissions staff to gather necessary information for thorough pre-authorizations and concurrent reviews.

    DUTIES AND RESPONSIBILITIES:

    • Using clinical knowledge and/or nursing experience, the Utilization Specialist reviews provider requests for inpatient and outpatient services, works closely with providers to collect all information necessary to perform a thorough medical necessity review.
    • Completes Peer reviews as necessary and or assisting in Peer reviews and Live Appeals with the appropriate person.
    • Participates in treatment team meetings, review client charts, complete requests for Single Case Agreements (SCA’s) or Letters of Agreement (LOA’s) with out of network insurance providers.
    • Write appeals, carry a caseload, and communicate interdepartmentally regarding insurance denials.
    • The role requires advanced understanding of clinical terminology, the ability to build rapport, and a strong grasp of medical necessity criteria.

    QUALIFICATIONS:

    • Bachelor’s in business administration or healthcare preferred
    • Previous utilization review experience in healthcare related fields with customer service experience

    Job Type: Full-time

    Pay: From $30,000.00 per year

    Benefits:

    • Dental insurance
    • Employee assistance program
    • Employee discount
    • Health insurance
    • Life insurance
    • Paid time off
    • Vision insurance

    Schedule:

    • Day shift
    • Monday to Friday

    Experience:

    • Utilization review: 1 year (Required)

    Work Location: In person

  • 12 Days Ago

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Utilization Review Nurse
  • Berkshire Hathaway GUARD Insurance Companies
  • Wilkes Barre, PA FULL_TIME
  • Overview Utilization Review Nurse Berkshire Hathaway GUARD Insurance Companies, an A Superior rated Insurance company is seeking a Utilization Review Nurse who is interested in joining a company with ...
  • 1 Month Ago

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Home Health RN Clinical Manager
  • Comprehensive Medical Home Care
  • Dupont, PA FULL_TIME
  • Comprehensive Medical Home Care is seeking a Registered Nurse to fulfill the Full Time Clinical Supervisor position. Minimum 2 years experience in Home Health required. This RN would work along-side t...
  • 1 Month Ago

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RN Case Manager Home Health - Per-Diem
  • Traditional Home Health Care
  • Berwick, PA PER_DIEM
  • Traditional Home Health Care Join our team of professionals and make a difference in someone's life. As an RN with Traditional Home Health Care, you are able to give each patient your undivided attent...
  • 19 Days Ago

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Registered Nurse (Weekend Program), RN Case Manager Home Health
  • Traditional Home Health Care
  • Scranton, PA FULL_TIME
  • Traditional Home Health Care Join our team of professionals and make a difference in someone's life. **$15,000 Sign-on Bonus for full-time RN Case Manager** Job Title: Registered Nurse (Weekend Progra...
  • 25 Days Ago

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Field Marketer - Home Care
  • Home Care LLC
  • Scranton, PA FULL_TIME
  • Join our home care team as a field marketer today! Duties include: - Develop and implement outreach strategies to promote awareness of our organization's programs and services- Conduct presentations a...
  • 17 Days Ago

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0 Utilization Review Manager - Home Care jobs found in Scranton, PA area

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Supervisor Sterile Processing: GCMC
  • Geisinger Health
  • Scranton, PA
  • Location: Geisinger Community Medical Center (GCMC) Shift: Days (United States of America) Scheduled Weekly Hours: 40 Wo...
  • 3/28/2024 12:00:00 AM

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Registered Nurse
  • Commonwealth Home Health Of Moses Taylor
  • Scranton, PA
  • We are hiring for a full-time Registered Nurse/RN to join our passionate team in Scranton, PA! PRN also available! At Co...
  • 3/28/2024 12:00:00 AM

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Psychiatrist Senior Medical Director - Behavioral Health
  • University of Pittsburgh Medical Center
  • Moosic, PA
  • We have an exciting opportunity for a full-time Senior Medical Director to join our leadership team with UPMC Community ...
  • 3/28/2024 12:00:00 AM

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Manager Electric Operations Linemen
  • Ugi Utilities Inc
  • Scranton, PA
  • At UGI Utilities, Inc. we believe in providing a superior range of energy products and services to our customers in a sa...
  • 3/26/2024 12:00:00 AM

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Manager Electric Operations Linemen
  • Ugi Utilities Inc
  • Kingston, PA
  • At UGI Utilities, Inc. we believe in providing a superior range of energy products and services to our customers in a sa...
  • 3/26/2024 12:00:00 AM

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RN - Registered Nurse Case Manager - Care Coordination
  • Geisinger
  • Taylor, PA
  • Job Title: RN - Registered Nurse Case Manager - Care Coordination Location: Wilkes-Barre, Pennsylvania Job Category: RN ...
  • 3/25/2024 12:00:00 AM

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RN - Registered Nurse Case Manager - Care Coordination
  • Geisinger
  • Ransom, PA
  • Job Title: RN - Registered Nurse Case Manager - Care Coordination Location: Wilkes-Barre, Pennsylvania Job Category: RN ...
  • 3/25/2024 12:00:00 AM

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Manager Electric Operations Linemen
  • UGI Utilities, Inc
  • Forty Fort, PA
  • At UGI Utilities, Inc. we believe in providing a superior range of energy products and services to our customers in a sa...
  • 3/25/2024 12:00:00 AM

Scranton is the sixth-largest city in the Commonwealth of Pennsylvania. It is the county seat and largest city of Lackawanna County in Northeastern Pennsylvania's Wyoming Valley and hosts a federal court building for the United States District Court for the Middle District of Pennsylvania. With a population of 77,291, it is the largest city in the Scranton–Wilkes-Barre–Hazleton, PA Metropolitan Statistical Area, which has a population of about 570,000. The city is conventionally divided into 7 districts: North Scranton, Southside, Westside, East Scranton (Hill Section), Central City, Minooka, ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$70,581 to $89,987
Scranton, Pennsylvania area prices
were up 1.5% from a year ago