Utilization Insurance Specialist Job at Mount Sinai Health System (New York)

Utilization Specialist

We are hiring a compassionate and experienced Utilization Specialist to work wit...

Location

United States , Scotts Valley

Salary:

25.00 - 27.00 USD / Hour

Acadia Healthcare

Expiration Date

Until further notice

Requirements

High school diploma or equivalent
Clinical experience is required, or two or more years' experience working with the facility's population
CPR and de-escalation and restraint certification required
First aid may be required based on state or facility requirements

Job Responsibility

Act as liaison between managed care organizations and the facility professional clinical staff
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements
Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay
Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office
Conduct quality reviews for medical necessity and services provided
Facilitate peer review calls between facility and external organizations
Initiate and complete the formal appeal process for denied admissions or continued stay
Assist the admissions department with pre-certifications of care
Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates
Perform other functions and tasks as assigned

What we offer

Competitive hourly rate
Shift differential for overnight shifts
Medical, dental, and vision insurance
Acadia Healthcare 401(k) plan
Excellent training program
Complimentary AOD Education to certify as a Substance Use Disorder Counselor
Professional growth opportunity

Fulltime

New

Pharmacy Assistant - ODB and Private Payor Insurance Claims Specialist

Experienced Pharmacy Assistant looking for something new and exciting? Maybe it'...

Location

Canada , Markham

Salary:

23.00 - 24.00 CAD / Hour

Randstad

Expiration Date

August 24, 2026

Requirements

Previous experience as a pharmacy assistant, regardless of the setting, is required
Exposrure to Kroll in a steady-to-fast paced pharmacy setting is preferred
Strong communication skills are crucial for this role
This role involves on-site work at all times (not remote, not hybrid)
Positive team spirit, initiative, and interest in a specialty setting are also a must

Job Responsibility

Manage multiple tasks related to prescription-related admin and calls to the programs and clinics to ensure faxes are received and they are aware of the same / requesting info related to prescription processing
Dispensing and managing patient medication administration in Kroll as part of duties
Demonstrate strong English communication skills, particularly when interacting with patients over the phone and in written communication
Calls require professionalism, empathy and clear communication as many calls require you to utilize your problem solving skills to support patients dealing with various conditions
Perform data entry tasks, including working with Kroll and supporting fax management

What we offer

Up to 3-month contract based on work performance with full-time hours (extension potential)
The pharmacy is clean, ergonomic, technologically advanced, and beautifully designed
The work schedule is Monday to Friday, with 8-hour shifts between 7:00 AM and 7:00 PM - all shifts must be worked as part of a rotation - no weekends, ensuring a better work-life balance
Insurance and benefits are optional through Randstad
Potential for this role to eventually transition into a permanent opportunity with the pharmacy
On-site, free parking is available for your convenience
Opportunity to learn alongside passionate pharmacy professionals who prioritize quality patient care in their practice

Fulltime

Utilization Review Specialist - PRN

San Jose Behavioral Health is currently seeking a Utilization Review Specialist ...

Location

United States , San Jose

Salary:

33.00 - 60.00 USD / Hour

Acadia Healthcare

Expiration Date

Until further notice

Requirements

Associate Degree in Nursing(LPN/LVN/RN) Required
Two or more year's experience with the population of the facility preferred
Previous experience in utilization management is preferred
LMFT, LMSW, LCSW, LPC, LPC-Iwithin the state where the facility provides services
or current clinical professional license or certification, as required, within the state where the facility provides services
CPR and de-escalation and restraint certification required (training available upon hire and offered by facility)
Bachelors or Masters degree in Social Work, Behavioral Health Or Mental Health, Nursing or Other related health field preferred

Job Responsibility

Coordinate and assess the inpatient census for appropriate alternate health care service needs
Perform on-site and/or telephonic concurrent review of acute and sub-acute services, as well as pre-certification review for all services following the plans authorization guidelines
Coordinate with appropriate discharge planning processes, providing feedback on documentation processes
Function as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options
Act as liaison between managed care organizations and the facility professional clinical staff
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements
Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay
Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office
Conduct quality reviews for medical necessity and services provided
Facilitate peer review calls between facility and external organizations

Insurance Verification Specialist

Our client in the local government and healthcare sector based in Baltimore, Mar...

Location

United States , Baltimore

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Applicant must have at least 1 year of experience in a similar role or related field
Proficiency in using EMR (Electronic Medical Records) is required
Experience in patient registration is essential
Ability to manage and update patient demographic information
Proficient in performing insurance verifications
Strong data entry skills are required
Knowledge and understanding of the health care industry is essential

Job Responsibility

Conducting regular follow up and communicating with clinic patients over the phone in a detail-oriented manner
Schedule patient visits, including new patient appointments, follow up visits, rescheduling of missed appointments, laboratory tests, and/or other medical appointments
Collecting and entering patient information such as insurance details, income, and family size into the electronic medical record
Utilizing clinical electronic medical records for data entry and management
Conducting patient registration, which includes obtaining demographic information
Ensuring data accuracy while entering into a spreadsheet and the electronic medical record
Making phone calls to patients to gather necessary details for calculating federal poverty limit
Monitoring patient accounts and taking actions when necessary

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Insurance Verification Specialist

Our client in the local government and healthcare sector based in Baltimore, Mar...

Location

United States , Baltimore

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Applicant must have at least 1 year of experience in a similar role or related field
Proficiency in using EMR (Electronic Medical Records) is required
Experience in patient registration is essential
Ability to manage and update patient demographic information
Proficient in performing insurance verifications
Strong data entry skills are required
Knowledge and understanding of the health care industry is essential

Job Responsibility

Conducting regular follow up and communicating with clinic patients over the phone in a detail-oriented manner
Schedule patient visits, including new patient appointments, follow up visits, rescheduling of missed appointments, laboratory tests, and/or other medical appointments
Collecting and entering patient information such as insurance details, income, and family size into the electronic medical record
Utilizing clinical electronic medical records for data entry and management
Conducting patient registration, which includes obtaining demographic information
Ensuring data accuracy while entering into a spreadsheet and the electronic medical record
Making phone calls to patients to gather necessary details for calculating federal poverty limit
Monitoring patient accounts and taking actions when necessary

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Social Media Manager - Insurance & Business Services Specialist

As a Social Media Manager - Insurance & Business Services Specialist at 321, you...

Location

United States , Orlando

Salary:

60000.00 - 75000.00 USD / Year

321 Brand + Social House

Expiration Date

Until further notice

Requirements

5+ years of experience in social media management, preferably in an agency environment managing multiple client accounts simultaneously
2+ years of direct experience managing social media for insurance brands (home insurance, auto insurance, personal lines) or financial services organizations required
Proven track record developing and executing successful social media strategies for insurance, business services, professional services, or B2B brands
Experience managing social media for insurance companies, insurance agencies, roofing companies, legal firms, real estate professionals, healthcare providers, or similar business services industries is highly valued
Deep understanding of insurance consumer behavior, purchase considerations, and content that drives trust and engagement in the insurance category
Knowledge of insurance industry regulations and advertising compliance requirements across multiple states/jurisdictions
Familiarity with insurance products, coverage types, claims processes, and industry terminology
Strong writing skills with ability to craft platform-appropriate content that resonates with insurance consumers and professional audiences while maintaining regulatory compliance
Expertise across major social media platforms including Facebook, Instagram, LinkedIn, TikTok, and YouTube, with deep understanding of platform-specific best practices
Proficiency with AI-powered content creation tools (ChatGPT, Claude, Jasper, Copy.ai, or similar) with demonstrated ability to produce high-quality, on-brand content efficiently

Job Responsibility

Develop comprehensive social media strategies for multiple insurance and business services client accounts that align with business objectives, target audiences, and brand positioning
Create insurance-specific content strategies that address the full customer lifecycle: awareness, quote consideration, policy purchase, claims experience, and renewal/retention
Understand and optimize for insurance consumer behavior including comparison shopping, life event triggers (home purchase, vehicle purchase, marriage, relocation), and seasonal patterns
Conduct competitive analysis, audience research, and platform audits to identify opportunities in insurance and business services verticals
Define content pillars, messaging frameworks, and brand voice guidelines tailored to insurance audiences and professional service consumers
Develop strategies that build trust and credibility for insurance brands while addressing common concerns (price transparency, claims reputation, coverage clarity, customer service quality)
Establish KPIs and success metrics for each client account, tracking performance against goals for reach, engagement, quote generation, and business impact
Leverage AI tools to analyze audience insights, predict content performance, and optimize strategy based on data-driven insights
Stay current on platform algorithm changes, emerging features, and social media trends in insurance marketing, adapting strategies to maximize organic reach
Monitor insurance industry trends, regulatory changes, and competitive landscape to inform content strategy

What we offer

Health, dental, and vision insurance
401K after one year of employment
2 Weeks (80 Hrs) Paid Time Off [Additional 40Hrs at 3 Years]
3 Sick/Mental Health Days
8 Hours Volunteer Time
Additional PTO at holiday and management discretion
Paid parental leave
Professional development opportunities
Leadership training opportunities and career advancement pathways
A collaborative, creative, and ambitious team environment

Fulltime

Registered Nurse, Stem Cell Transplant Coordinator

Baptist MD Anderson is looking to add a Registered Nurse (RN) as a Stem Cell Tra...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

3-5 Years of Oncology Experience Required
Bachelor of Science in Nursing Required
Registered Nurse (RN) - State Nursing Boards Required
Basic Life Support (BLS) - AHA Required

Job Responsibility

Demonstrate expert knowledge of SCT process and complex pre-transplant care
Direct plan of care with the patient and the multidisciplinary team
Coordinate and conducts patient and family education utilizing SCT Patient Education Manual and Patient Education online
Assess needs for multidisciplinary support and organize consultations with other areas in a timely and efficient manner
Direct all pre-admission activities to include donor activities (if applicable), treatment orders, consents, education, tours, documentation and pre-admit requisitions to ensure a smooth, seamless transition for patients and family members to the inpatient setting
Organize all diagnostics needed pre-transplant
Responsible for scheduling admissions and preparing the appropriate paperwork to assure a clear and concise admission process
Collaborate with cellular therapy finance specialists and liaise with insurance case managers to ensure appropriate authorizations, timely utilization review, and maximize program reimbursement
Utilize and update appropriate database communication tools
Support CIBMTR, required outcome reporting agency, compliance through direct contact with and support of the Oncology Data Coordinator

Fulltime

Patient Financial Specialist Lead - Patient Financial Services

The associate is responsible for the duties and services that are of a support n...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

HS Diploma or equivalency required
Post HS education preferred
5-7 years of experience preferred
Demonstrated success working in a team environment focused on meeting organization goals and objectives required
Experience in role requirements as outlined in job description for specific area of responsibility preferred
College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience
Must have an understanding of alternative Business Office financial resources and the ability to provide information and/or recommendations related to these sources of recovery are preferred
Experience working within a multi-facility hospital business office environment preferred
None required

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Functions as a subject matter expert in support of other PFS team members and other departments/facilities within the CHRISTUS Health network
Provide on-the-job training as needed and provide a source of knowledge for staff inquiries
Demonstrates a strong understanding of payer benefits requirements, on-line claims status, submission, billing, cash application, and reconciliation procedures
Approve or deny requested adjustments and refunds within role thresholds
Adapt to process and procedure evaluations and improvements, support continuous change, and willingly manage special projects in addition to normal workload and other duties as assigned
Remain flexible if duties are reassigned, which may involve transferring to a more appropriate unit in order to best serve PFS and CHRISTUS Health
Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution while maintaining account integrity and compliance with payer and/or government regulations
Ensures quality and productivity standards are met or exceeded
Appropriately documents patient accounting host system or other systems utilized by Patient Financial Services in accordance with policy and procedures

Fulltime

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Utilization Insurance Specialist

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