Utilization Review Technician jobs in Mount Pleasant, SC

Utilization 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. Being a Utilization Review Technician 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 Technician 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). The Utilization Review Technician gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Utilization Review Technician typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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Utilization Review Nurse/Case Manager
  • Health Partners Management Group
  • Charleston, SC FULL_TIME
  • SUMMARY: This position will actively and retrospectively review medical cases to confirm that patient receive appropriate care and ensures cost effectiveness of health care services. Utilization management relates to all components in the health care system including primary, specialty and inpatient settings.

    • LOCATION: W Hill Blvd, Joint Base Charleston, SC 29404
    • HOURS: 40 hours/week
    • PAY: $37.52/hour

    BENEFITS:

    • 2 weeks’ vacation in the 1st 12 months plus…
    • Major holidays off
    • Medical, Vision, Dental, AD&D, & Life Insurances

    REQUIREMENTS:

    • Baccalaureate of Science in Nursing from the ACEN, NLNAC, or CCNE
    • Nurse applicants must be a current U.S. licensed Registered Nurse.
    • 6 years of clinical nursing experience within the last 36 months
    • 1 year of previous experience in Utilization Management

    MANDATORY KNOWLEDGE AND SKILLS:

    • Knowledge, skills and computer literacy to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care Guidelines.
    • Must possess experience in performing prospective, concurrent, and retrospective reviews to justify medical necessity for medical care to aid in collection and recovery from multiple insurance carriers. Review process includes Direct Care and Purchase Care System referrals, ward rounds for clinical data collection, contacting providers to inform them of dollars lost for missing documentation, and providing documentation for appeals resolution.
    • Possesses working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), International Classification of Diseases-Version 9 (ICD), and Current Procedural Terminology-Version 4 (CPT-4) coding.
    • Possess excellent oral and written communication skills, interpersonal skills, and have working knowledge of computers, specifically the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows.

    UNIQUE MILITARY HEALTH CARE SYSTEMS/PROCEDURES: The Composite Health Care System (CHCS), MHS GENESIS, Armed Forces Health Longitudinal Technology Application (AHLTA), and ICD-B programs must be utilized for referral management services. Access will be granted by local MTF connectivity and the contractor shall comply with MHS communications and Government IT security standards and policies. The military facility will provide system accounts for MSS personnel after required training and security procedures have been completed by the contractor. If the Military Health Service processes moves away from specified systems, the government will modify the task order accordingly.

    PERFORMANCE OUTCOMES:

    • Assist with orientation and training of other Medical Management staff and assist in providing, assessing, and improving a wide variety of customer service relations. Assists MTF officials to ensure Health Service Inspection standards are met at the operational level.
    • Assists in the development and implementation of a comprehensive Utilization Management plan/program for beneficiaries within MTF’s goals and objectives. This plan is based on using the 12-step approach as described in the DoD Medical Management Guide.
    • Reviews previous and present medical care practices as needed for patterns, trends, or incidents of under or over utilization of hospital resources incidental to medical care provided to beneficiaries.
    • Plans and performs reviews IAW established indicators and guidelines to provide quality cost-effective care. Ensures identified patient needs are addressed promptly with appropriate decisions. Provides timely, descriptive feedback regarding utilization review issues.
    • Performs data/metric collection. Analyzes data and prepares reports to describe resource utilization patterns. Briefs applicable data/slides to provider staff, executive staff, newcomers, as appropriate. Identifies areas requiring intensive management or areas for improvement.
    • Maintains reports on which cases have been denied or received reduced third-party payments and reports provider profiles to the MTF management for corrective action.
    • Serves as a liaison with higher headquarters, TRICARE Regional Office, MTF national accreditation organization, professional organizations, and community health care facilities concerning Utilization Management.
    • Participates in in-services and continuing education programs. Briefs applicable data/slides to provider staff, executive staff, newcomers, as appropriate.
    • Establishes and maintains good interpersonal relationships with co-workers, families, peers, and other health team members. Submits all concerns through Utilization Management Director; be able to identify, analyze and make recommendations to resolve problems and situations regarding referrals.
    • Be productive and perform with minimal oversight and direction. Be able to independently identify, plan, and carry out projects with consideration for the goals and objectives of the TRICARE Utilization Management Element. Develops detailed procedures and guidelines to supplement established administrative regulations and program guidance. Recommendations are based upon analysis of work observations, review of procedures, and application of guidelines.

    WORK ENVIRONMENT/PHYSICAL REQUIREMENTS: The work can be sedentary. However, there may be some physical demands. Requirements include standing, sitting or bending. Individual will be required to walk throughout facility to pick up family practice clinic, medical records, and radiology mail drop offs/signed referrals.

    Job Type: Full-time

    Salary: Up to $37.52 per hour

    Work Location: In person

    Job Type: Full-time

    Pay: $37.52 per hour

    Expected hours: 40 per week

    Benefits:

    • Dental insurance
    • Disability insurance
    • Free parking
    • Health insurance
    • Life insurance
    • Paid time off
    • Referral program
    • Vision insurance

    Healthcare setting:

    • Hospital

    Schedule:

    • 8 hour shift
    • Day shift
    • Monday to Friday
    • No nights
    • No weekends

    Experience:

    • Clinical Nursing: 6 years (Required)
    • Utilization review: 1 year (Required)

    License/Certification:

    • RN License (Required)

    Ability to Relocate:

    • Charleston, SC: Relocate before starting work (Required)

    Work Location: In person

  • 13 Days Ago

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Low Voltage Technician
  • Next Level Technician
  • Charleston, SC FULL_TIME
  • Next Level Technician is seeking Low Voltage Technicians in the Charleston, SC area. Candidates that are highly motivated and ready to work in a hands-on environment are encouraged to explore this opp...
  • 3 Days Ago

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Access Control Technician
  • Next Level Technician
  • Harleyville, SC FULL_TIME
  • Next Level Technician is urgently hiring Access Control Technicians for a long-term, career-shaping opportunity in the Columbia and Charleston, SC areas! Apply for a position in the telecommunications...
  • 4 Days Ago

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Cable puller
  • Next Level Technician
  • Charleston, SC FULL_TIME
  • Next Level Technician is urgently hiring Low Voltage Cable Technicians for a long-term, career-shaping opportunity! Why work at Next Level Technician? Not only do we offer competitive pay, sign on bon...
  • 1 Month Ago

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Document Review Law Clerk
  • Carolina Legal Associates
  • Charleston, SC FULL_TIME
  • A well-established firm in Charleston, SC has an immediate need for on-site document review law clerks and attorneys to start on a project that is expected to be ongoing. This is a great opportunity t...
  • 3 Days Ago

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Medical Review Specialist
  • Motley Rice LLC
  • Mount Pleasant, SC FULL_TIME
  • SUMMARY: Under general supervision of the Client Services Team Lead, the Medical Review Specialist assists paralegals and attorneys by reviewing and compiling medical and pharmacy records required for...
  • 17 Days Ago

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0 Utilization Review Technician jobs found in Mount Pleasant, SC area

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Cardiovascular Technician
  • Trident Medical Center
  • Mount Pleasant, SC
  • DescriptionIntroduction Are you looking for a work environment where diversity and inclusion thrive? Submit your applica...
  • 3/29/2024 12:00:00 AM

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Landscaping Technician
  • Superior Contracting & Maintenance
  • Charleston, SC
  • Superior Contracting & Maintenance is currently seeking a skilled Landscaping Technician to join our team. As a Landscap...
  • 3/29/2024 12:00:00 AM

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Pharmacy Technician
  • Costco Wholesale Corporation
  • Charleston, SC
  • Job Description Assists pharmacist to fill, dispense prescriptions for customers. Assists customers at counter, retrieve...
  • 3/28/2024 12:00:00 AM

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Pharmacy Technician
  • Costco Wholesale Corporation
  • Mount Pleasant, SC
  • Job Description Assists pharmacist to fill, dispense prescriptions for customers. Assists customers at counter, retrieve...
  • 3/28/2024 12:00:00 AM

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Guitar Technician
  • Guitar Center
  • Mount Pleasant, SC
  • Description Why Guitar Center? Heres just some of the rewards: For our employees who are musicians we offer the unique o...
  • 3/26/2024 12:00:00 AM

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Guitar Technician
  • Guitar Center
  • North Charleston, SC
  • Description Why Guitar Center? Heres just some of the rewards: For our employees who are musicians we offer the unique o...
  • 3/26/2024 12:00:00 AM

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Guitar Technician
  • Guitar Center
  • Isle Of Palms, SC
  • Description Why Guitar Center? Heres just some of the rewards: For our employees who are musicians we offer the unique o...
  • 3/26/2024 12:00:00 AM

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Guitar Technician
  • Guitar Center
  • Sullivans Island, SC
  • Description Why Guitar Center? Heres just some of the rewards: For our employees who are musicians we offer the unique o...
  • 3/26/2024 12:00:00 AM

Mount Pleasant is a large suburban town in Charleston County, South Carolina, United States. It is the fourth largest municipality and largest town in South Carolina, and for several years was one of the state's fastest-growing areas, doubling in population between 1990 and 2000. The population was 67,843 at the 2010 census,. The estimated population in 2014 was 77,796. At the foot of the Arthur Ravenel Bridge is Patriots Point, a naval and maritime museum, home to the World War II aircraft carrier USS Yorktown, which is now a museum ship. The Ravenel Bridge, an eight-lane highway that was c...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Technician jobs
$59,605 to $83,170
Mount Pleasant, South Carolina area prices
were up 1.5% from a year ago

Utilization Review Technician in Winston Salem, NC
When considering cost of living, this places Durham, NC as 3rd out of the 4 largest nearby metros in terms of quality of life for Utilization Review Technicians**.
January 02, 2020
Utilization Review Technician in Fairbanks, AK
Current National Pharmacy Technician Certification (PTCB, ExCPT or NCCT) required.
February 03, 2020
Utilization Review Technician in Little Rock, AR
Based on our compensation data, the estimated salary potential for Utilization Review Technician will increase 16 % over 5 years.
February 07, 2020