Talent.com
Utilization Management Scheduler
Utilization Management SchedulerVitalCore Health Strategies • Hopkinton, MA, US
Utilization Management Scheduler

Utilization Management Scheduler

VitalCore Health Strategies • Hopkinton, MA, US
job_description.job_card.30_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.part_time
job_description.job_card.job_description

Job Description

Job Description

Join the VitalCore Team in Massachusetts! We're people who are fueled by passion, not by profit.

VitalCore Health Strategies, (VCHS), an industry leader in Correctional Healthcare, has an opening for a Part-Time (16 hours per week) Utilization Management Scheduler at the Regional Office in Hopkinton, MA!

Looking for a rewarding career in the field of healthcare?

At VitalCore we pride ourselves on retaining and acquiring hardworking ethical individuals who are committed to providing quality services. Join our team and experience first-hand how VitalCore Health Strategies promotes a positive work environment that is based on respect and appreciation of the hard work and dedication of our staff.

UTILIZATION MANAGEMENT SCHEDULER BENEFITS :

  • Holiday Pay : New Year’s Day, Martin Luther King Jr. Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Veteran’s Day, Thanksgiving Day, and Christmas Day
  • Medical
  • Dental
  • Vision
  • Health Savings Account
  • Dependent Care Flexible Spending Account
  • Life Insurance
  • Short Term / Long Term Disability
  • Identity Theft Protection
  • Pet Insurance
  • Employee Assistance Program and Discount Center
  • 401K & Plan Matching
  • PTO

UTILIZATION MANAGEMENT SCHEDULER POSITION SUMMARY :

The Utilization Management Scheduler is responsible for case management for patients to advocate for optimum healthcare.

UTILIZATION MANAGEMENT SCHEDULER ESSENTIAL FUNCTIONS :

  • Responsible for accurate flow of medical information between patients, outside providers, and third-party payers.
  • Researches and analyzes data for accuracy required for reimbursement.
  • Analyzes medical billing and identifies documentation deficiencies.
  • Uses established criteria to conduct preliminary decision review for services requiring prior authorization.
  • Assess the need for additional information to complete a service decision request.
  • Works closely with UM team to escalate decision that require clinical review and oversight.
  • Communicates results of reviews in UM program for the primary care team and clinical reviewers.
  • Handles all requests for review of authorization and data accuracy timely and efficiently.
  • Follows department and organizational policies and procedures as well as adheres to all applicable regulatory, contractual, and compliance requirements.
  • Maintain proficiency with technology such as Microsoft, Excel, and other platforms as required.
  • Maintain great customer service skills, including interpersonal conversation, patience, and empathy.
  • Problem-solve and use critical thinking skills.
  • Maintain knowledge of CPT and ICD coding, as required. Provide flexibility and understanding of individualized care plans.
  • Work efficiently independently to make decisions and in a team, as needed.
  • Maintain security of patient information / adhere to HIPPA requirement.
  • Other duties as assigned.

    • UTILIZATION MANAGEMENT SCHEDULER MINIMUM REQUIREMENTS :

  • Associate’s degree or equivalent experience – Bachelor’s degree preferred.
  • Has an active certification in Medical Coding.
  • 10+ years professional work experience in healthcare, managed care, or insurance preferred.
  • Education, training, or experience as a medical coder, medical billing, or insurance coordinator required.
  • Must be fluent in English language, including reading, writing, speaking, and understanding.
  • Must be a supportive team member, who contributes to and demonstrates teamwork and team concept.
  • Able to make independent decisions when circumstances warrant such action.
  • Able to deal tactfully with personnel, family members, visitors, government agencies / personnel, and the general public.

    • VitalCore Health Strategies is an equal opportunity employer and is committed to creating and maintaining an inclusive workplace in which all employees have an opportunity to participate and contribute to the success of the business and are valued for their skills, experience, and unique perspectives.

    Keywords : Registered Nurse, Utilization, UM RN #indnc

    Part-Time

    Day Shift

    serp_jobs.job_alerts.create_a_job

    Scheduler • Hopkinton, MA, US

    Job_description.internal_linking.related_jobs
    Travel Echo Ultrasound Technologist

    Travel Echo Ultrasound Technologist

    AHS Staffing • Attleboro, MA, US
    serp_jobs.job_card.full_time
    AHS Staffing is seeking a travel Echo Technologist for a travel job in Attleboro, Massachusetts.Job Description & Requirements. AHS Staffing is looking for a Echo Ultrasound Technologist in Attl...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Utilization Management Nurse Consultant

    Utilization Management Nurse Consultant

    VirtualVocations • Worcester, Massachusetts, United States
    serp_jobs.job_card.full_time
    A company is looking for a Utilization Management Nurse Consultant specializing in Medical Review (Remote).Key Responsibilities Implement, coordinate, monitor, and evaluate medical review cases u...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Utilization Management Nurse RN

    Utilization Management Nurse RN

    VirtualVocations • Worcester, Massachusetts, United States
    serp_jobs.job_card.full_time
    A company is looking for a Utilization Management Nurse RN.Key Responsibilities Compose well-structured appeal letters using data extraction and appropriate medical literature references Ensure ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_1_day • serp_jobs.job_card.promoted
    Utilization Management Coordinator

    Utilization Management Coordinator

    VirtualVocations • Lowell, Massachusetts, United States
    serp_jobs.job_card.full_time
    A company is looking for a Utilization Management Intake Coordinator.Key Responsibilities Handles incoming authorization requests efficiently and accurately Determines authorization requirements...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Program Scheduler, Senior - TS / SCI / SAP

    Program Scheduler, Senior - TS / SCI / SAP

    DCS Corporation • Bedford, MA, United States
    serp_jobs.job_card.full_time
    DCS has an exciting opportunity for a.Command, Control, Communications, and Battle Management Division (C3BM).Command, Control, Communications, and Battle Management (C3BM) has been tasked with del...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Scheduling Specialist

    Scheduling Specialist

    VirtualVocations • Lowell, Massachusetts, United States
    serp_jobs.job_card.full_time
    A company is looking for a Scheduling Specialist responsible for coordinating patient appointment scheduling for medical equipment and services. Key Responsibilities Schedule and coordinate delive...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Radiology Scheduler

    Radiology Scheduler

    VirtualVocations • Worcester, Massachusetts, United States
    serp_jobs.job_card.full_time
    A company is looking for a Radiology Scheduler to work from home at a rate of $16.Key Responsibilities Schedule radiology appointments including mammograms, ultrasounds, MRIs, and CTs Address qu...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Scheduler for Valuations

    Scheduler for Valuations

    VirtualVocations • Worcester, Massachusetts, United States
    serp_jobs.job_card.full_time
    A company is looking for a Scheduler, Valuations to manage appraisal order needs and coordinate appointments.Key Responsibilities Assess order requirements and client / vendor needs Coordinate sch...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
    Behavioral Health Utilization Review RN

    Behavioral Health Utilization Review RN

    VirtualVocations • Worcester, Massachusetts, United States
    serp_jobs.job_card.full_time
    A company is looking for a Behavioral Health Utilization Review RN for a full-time remote position.Key Responsibilities Review and evaluate electronic medical records for emergency admissions and...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Healthcare Project Delivery Manager

    Healthcare Project Delivery Manager

    VirtualVocations • Lowell, Massachusetts, United States
    serp_jobs.job_card.full_time
    A company is looking for a Product Delivery Manager specializing in Healthcare, particularly in Medicaid and Medicare.Key Responsibilities Drive end-to-end delivery of high-impact healthcare proj...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_1_day • serp_jobs.job_card.promoted
    Speech Pathologist

    Speech Pathologist

    Encompass Health • Sturbridge, MA, US
    serp_jobs.job_card.full_time +1
    Speech Pathologist Career Opportunity.Welcome to Encompass Health : Where Compassion Meets Speech Therapy.Are you searching for a career that aligns with your passion and brings fulfillment close to...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_1_hour • serp_jobs.job_card.promoted • serp_jobs.job_card.new
    Utilization Management Nurse

    Utilization Management Nurse

    VirtualVocations • Lowell, Massachusetts, United States
    serp_jobs.job_card.full_time
    A company is looking for a Utilization Management Nurse to review and monitor healthcare service utilization for members. Key Responsibilities Conducts concurrent and retrospective reviews of faci...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Centralized Scheduling Coordinator

    Centralized Scheduling Coordinator

    VirtualVocations • Lowell, Massachusetts, United States
    serp_jobs.job_card.full_time
    A company is looking for a Centralized Scheduling Coordinator.Key Responsibilities Coordinate surgeries, procedures, exams, therapies, and evaluations across multiple departments and facilities ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Outbound Outreach Coordinator

    Outbound Outreach Coordinator

    VirtualVocations • Lowell, Massachusetts, United States
    serp_jobs.job_card.full_time
    A company is looking for an Outbound Outreach Coordinator, remote position.Key Responsibilities Make high-volume outbound calls to members, introducing programs and inviting participation Captur...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Utilization Management Technician

    Utilization Management Technician

    VirtualVocations • Worcester, Massachusetts, United States
    serp_jobs.job_card.full_time
    A company is looking for a Utilization Management Technician.Key Responsibilities Coordinate, generate, and track correspondence, faxes, and authorizations related to utilization management Inte...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Echo Technologist

    Travel Echo Technologist

    PRIDE Health • Gardner, MA, US
    serp_jobs.job_card.full_time
    PRIDE Health is seeking a travel Echo Technologist for a travel job in Gardner, Massachusetts.Job Description & Requirements. PRIDE Health is the minority-owned healthcare recruitment division o...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_1_day • serp_jobs.job_card.promoted
    Maine Licensed Utilization Management Nurse

    Maine Licensed Utilization Management Nurse

    VirtualVocations • Lowell, Massachusetts, United States
    serp_jobs.job_card.full_time
    A company is looking for a Utilization Management Nurse RN - Remote.Key Responsibilities Validates authorization for procedures and manages concurrent cases to resolution Conducts medical necess...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Special Assignment Ops Supervisor

    Special Assignment Ops Supervisor

    Federal Express Corporation • Wilmington, MA, United States
    serp_jobs.job_card.full_time
    This is a frontline supervisor position that supports the FedEx Safety Above All Culture and manages specific day-to-day operations and an assigned staff. Responsible for ensuring safe and efficient...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_1_day • serp_jobs.job_card.promoted