Franciscan Health logo
Franciscan Health

Hospitals and healthcare services in Indianapolis, Lafayette, northwest and western Indiana and south-suburban Chicago.

Utilization Review Coordinator

GeneralGeneralFull TimeRemoteSeniorTeam 10,001+Since 1875H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

4 days ago

Salary

$57.0K - $84.7K / year

Seniority

Senior

Associate Degree3 yrs expEnglish

Job Description

Utilization Review Coordinator

Franciscan Health

• Perform admission screening for patients in a bed for medical necessity • Perform concurrent reviews for appropriateness of utilization to optimize clinical and financial outcomes • Communicate with physicians, patients, members of the Healthcare team, Coordinated Business Office staff, Denial Management staff, and third-party payors to justify the admission or continued stay • Notify appropriate staff members of any admission, service, length of stay, lack of medical necessity criteria, as well as denials/appeals and issuing of letters to patients • Provide Physician, Patient, Family, Staff and Student education • Act as a resource person for the case management department regarding payer rules, regulations, policies and procedures, and utilization issues • Perform admission necessity screening using criteria as established by the various federal, state and private sector programs

Job Requirements

  • Associate degree in nursing/patient care required
  • Bachelor's Degree in nursing/patient care preferred
  • Registered Nurse (RN - Indiana licensure) required
  • 3 years of nursing/patient care experience required
  • 2 years of Utilization or Case Management experience preferred

Benefits

  • Comprehensive benefit offerings

Related Job Pages

More General Jobs

Sutter Health logo

Clinical Triage Nurse

Sutter Health

An integrated network delivering accessible, high-quality, and life-saving healthcare when people need it most.

General4 days ago
Full TimeRemoteTeam 10,001+Since Sutter Health was founded in 1996.H1B Sponsor

• Aids patients in obtaining the correct level of care with the appropriate provider at the right time • Provides advance clinical telephone support to Sutter Health patients, other callers, in-basket and other remote support for physicians, and limited in-clinic support • Uses the nursing process, input from physicians, and Sutter Health's approved telephone nursing guidelines and protocols to maintain highly efficient operations • Assesses patients' needs, appropriately dispositions cases, collaborates with clinic and hospital-based providers to renew electronic prescriptions, identifies hospital/community resources, consultations/referrals, and performs nursing follow-up activities • Clinical support includes assisting physician partners with message management and other communications within the electronic medical record (EMR) system

Arizona + 5 moreAll locations: Arizona | Louisiana | Montana | Missouri | South Carolina | Tennessee
$37 - $48 / hour
Job Closed
Conservice logo

Validation Processor

Conservice

Conservice is a utility management and billing company founded in 2000. As an employer, Conservice strives to provide its team with a creative work environment

General4 days ago

Role Description This position is responsible for validating scanned utility invoices. This position is a work from home opportunity with 19-29 hours per week and could follow the school year schedule if desired. Employee must provide high-speed internet, PC and corresponding hardware. - Validate information on scanned utility invoices - Resolve invoice information by correcting invalid fields - Examine current processes and recommend any process improvement efficiencies - Identify recurring problem invoices and route for correction Qualifications - Ability to work independently - Strong Ten Key preferred - Moderate Computer Skills including e-mail, internet browsing and Adobe Reader Requirements - Detail Orientated - Accuracy - Multi-tasking - Time Management - Self-Motivation - Excellent Problem Solving Skills - Organizing and Prioritizing

United States
SimonMed Imaging logo

MRI Technologist

SimonMed Imaging

Physician owned outpatient medical imaging provider.

General4 days ago
Full TimeRemoteTeam 1,001-5,000Since 2003H1B No Sponsor

• Operates the ROCC Magnetic Resonance operations at SimonMed Imaging centers for their assigned region • Competent in performing all general and advanced level imaging procedures and provide support for the onsite positioning technologist(s) as needed • Checks the order for complete information, proper exam and schedules as needed • Obtains sufficient information to determine the priority of the exam performed • Performs MR procedures at a technical level not requiring constant supervision of technical detail • Operates equipment safely and maintains SimonMed standards while performing all types of procedures, protocols, QA guidelines and regulatory requirements • Works under general supervision of the ROCC MR Lead • Interacts appropriately with patients, staff, and all care providers • Knowledge of magnetic resonance imaging procedures and technology

United States
$33 - $36 / hour

Staff Dentist

LIBERTY DENTAL PLAN CORPORATION

LIBERTY Dental Plan is committed to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential.

General4 days ago

Role Description Liberty Dental Plan is looking for a Nevada and New Jersey Licensed Staff Dentist to join our growing team! Unrestricted license or certification to practice dentistry in the State of Nevada & New Jersey. Ready to take your clinical expertise beyond the traditional practice setting? At LIBERTY Dental Plan, our Staff Dentists play a critical role in shaping how quality dental care is delivered at scale. In this fully remote position, you’ll use your clinical judgment to review claims and prior authorizations, helping ensure members receive the right care at the right time. Your work directly influences patient outcomes, supports providers, and strengthens the integrity of dental benefits across Commercial, Marketplace, Medicare Advantage, and Medicaid programs. This is more than a review role—it’s an opportunity to collaborate with experienced clinical leaders, contribute to meaningful quality initiatives, and grow your impact within a mission-driven organization dedicated to improving oral health nationwide. What You’ll Do - Utilization Management & Clinical Review - Review dental claims and prior authorization requests, applying coverage guidelines and benefit plan policies to ensure accurate determinations. - Interpret dental records, radiographs, and clinical documentation to assess medical necessity. - Meet established productivity and quality benchmarks for clinical reviews. - Document clear, concise clinical rationale aligned with regulatory and accreditation standards. - Calibration & Clinical Consistency - Participate in calibration sessions to ensure consistent application of clinical guidelines and policies. - Complete interrater reliability assessments and meet accuracy benchmarks. - Raise complex or unclear cases for peer discussion and resolution. - Incorporate feedback from audits and reviews to continuously improve accuracy. - Provider Engagement & Peer Review - Conduct peer-to-peer consultations with providers regarding clinical decisions and treatment alternatives. - Support grievance and appeal reviews with clinical insight. - Collaborate with dental specialists and internal teams on complex cases. - Training, Collaboration & Compliance - Participate in clinical trainings and team meetings. - Partner with Utilization Management, Claims, Dental Directors, and Grievances & Appeals teams. - Support regulatory reporting and maintain knowledge of applicable standards and guidelines. - Stay current on ADA coding updates and evidence-based clinical practices. A Day in the Life - ~90% of your time reviewing prior authorizations and dental claims using internal systems (including AI-supported platforms). - Interpreting clinical documentation and applying your judgment to ensure accurate, compliant determinations. - ~10% of your time participating in calibration sessions, identifying trends (including fraud, waste, and abuse), and supporting workflow improvements. You’ll start your day by logging in, reviewing assigned cases, and managing your review queue while maintaining quality and turnaround expectations. You’ll also engage with colleagues and providers as needed to support accurate and consistent outcomes. Qualifications - DDS or DMD from an accredited institution. - Active, unrestricted Nevada and New Jersey dental license in good standing (required). - Minimum 6 years of experience as a practicing dentist. - Experience with claims review, utilization management, or quality initiatives preferred. Requirements - Strong clinical judgment and ability to evaluate dental necessity and treatment appropriateness. - Ability to interpret dental radiographs and clinical records. - Knowledge of managed care systems, reimbursement models, and regulatory requirements. - Strong written communication skills to document clear and defensible clinical decisions. - Ability to manage high-volume review work efficiently while maintaining accuracy. - Comfort working in a remote, structured environment during standard business hours. - Proficiency with computer systems and ability to learn new technology platforms, including AI-supported tools. Work Environment & Expectations - Fully remote position. - Structured schedule aligned with core business hours (not a flexible-hours role). - Highly collaborative environment with cross-functional teams. - Focus on productivity, accuracy, and quality outcomes. Compensation - Salary Range: $150,000 – $165,000 annually. - (Final compensation will depend on experience, qualifications, and licensure.) Benefits - Competitive pay structure and savings options to help you reach your financial goals. - Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines. - Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan. - 100% employer-paid dental coverage for employees and eligible dependents. - Vision insurance with low-cost premiums for employee-only coverage and dependents. - Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage. - Flexible Spending Accounts for healthcare and dependent care expenses. - Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance. - Long-term disability coverage. - Expansive wellness programs, including company-wide wellness challenges, and gym discounts. - Employee Assistance Program (EAP) to support mental health and well-being. - Generous vacation and sick leave policies, with the ability to roll over unused time. - 10 paid company holidays. - Tuition reimbursement for eligible educational expenses. - Remote or hybrid work options available for various positions.

United States
$150K - $165K / year