Jobs in the United States

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DB
Customer Service Lead SFV, CA Job 477.26
Default Brand
San Luis Obispo, CA
- $20 to $27 USD / hour
Must have the ability to communicate clearly both written and verbal · Workdays vary depending on location; some are open 7 days per week
Added just now
Metrologist ll
Arrowhead Pharmaceuticals
Verona, WI
Candidates must have current, valid authorization to work in the country where this role is located
Added just now
Case Manager
Chicago Public Schools
IL
In order to be successful and achieve the above responsibilities, the Case Manager, must possess the following qualifications, as described:
Added 1 min ago
D
Patient Care Technician
DAVITA
Bronx, NY
- $23.5 to $36.5 USD / hour
Added 1 min ago
Distribution Account Manager
RBC
United States
Analytical mindset with the ability to interpret data and market insights to drive informed decisions.
Added 1 min ago
Senior Manager, Growth, The AI Access Initiative
Evidence Action
Remote, United States
Use data and analysis to understand growth opportunities, improve decision-making, and help prioritize where we invest.
Added 1 min ago
AVP, Federal Sales
Samsara
Remote, United States
…on physical operations to harness Internet of Things (IoT) data to develop actionable insights and improve their operations. At Samsara, we are helping improve the safety, efficiency and…
Added 1 min ago
FL
Summer 2027 Undergraduate Internship - Operations
FMR LLC
Westlake, TX · Boston, MA · Covington, KY · Durham, NC · Jersey City, NJ · Merrimack, NH · Smithfield, RI
- $20 to $32 USD / hour
Added 1 min ago
BH Care Manager - LP (Buncombe County, NC)
Partners Behavioral Health Management
Asheville, NC
LOCATION: Remote – must live in or near Buncombe County, North Carolina
Added 1 min ago
Client Value Manager I
Curinos Inc
New York, NY
…every decision. Our AI-first platform transforms proprietary data, advanced analytics and deep financial services expertise into timely recommendations - delivered right where teams work.…
Added 1 min ago
Senior Client Value Manager
Curinos Inc
New York, NY
…every decision. Our AI-first platform transforms proprietary data, advanced analytics and deep financial services expertise into timely recommendations - delivered right where teams work.…
Added 2 mins ago
Application Systems Engineer
AG Consulting Partners, Inc.
Olympia, WA
· Create and maintain PowerShell scripts to automate administrative tasks, configuration, data gathering, troubleshooting, deployment, and maintenance activities.
Added 2 mins ago
Strategic Account Executive, Partner Store
Nitrogen
Remote, United States
…certification, Nitrogen is built on fifteen years of advisor data and half a trillion dollars in assets on platform. We invented the Risk Number®, built on a Nobel Prize-winning academic…
Added 2 mins ago
MC
Director of Human Resources
Madera County Superior Court
Madera, CA
- $117,225 to $142,488 USD / year
Oversees and ensures the accurate maintenance of personnel records, including new hires, terminations, promotions, and other personnel data.
Added 3 mins ago
CO
Emergency Management Coordinator - LTE
City of Issaquah
Issaquah, WA
- $44.02 to $57.93 USD / hour
Conducts research, compiles information, collects data, analyzes data, and prepares reports.
Added 3 mins ago
WH
ED RN Part-Time 3a-3p
Wellstar Health System
Douglasville, GA
- Part-time
…Wellstar Health Systems safety absolutes * C.Participates in data collection, poses relevant clinical questions to advanced evidence-based practice. Consults appropriate experts and uses…
Added 3 mins ago
Physical Security Engineer
Prime Data Centers
Remote, United States
Prime Data Centers develops, acquires, and operates data centers for some of the world's largest enterprises. A private firm owned by a group controlling $6 billion in assets, with a…
Added 3 mins ago
Senior Software Engineer I
NHA
Grand Rapids, MI
…development tools responsibly, with care for the student and staff data our systems…
Added 3 mins ago
Cyber Security Analyst
NHA
Grand Rapids, MI
Analyze security data to identify and investigate potential security incidents and threats.
Added 3 mins ago
Environmental Health & Safety Manager
Reynolds Consumer Products
Malvern, AR
…manufacturing practices, and enables continuous improvement through data-driven decision making. Exercises significant autonomy in evaluating risk, prioritizing initiatives, and…
Added 3 mins ago
BP
Sr. Director/Managing Director, Paid Media + Partnerships
Bully Pulpit International
Remote, United States
- $180,000 to $225,000 USD / year
Bully Pulpit International is an outcomes agency made up of strategists, data scientists, and artists. We come from politics, brands, and government and we communicate without barriers and…
Added 3 mins ago
BP
Sr. Director/Managing Director, Paid Media + Partnerships
Bully Pulpit International
Remote, United States
- $180,000 to $225,000 USD / year
Bully Pulpit International is an outcomes agency made up of strategists, data scientists, and artists. We come from politics, brands, and government and we communicate without barriers and…
Added 3 mins ago
BP
Sr. Director/Managing Director, Paid Media + Partnerships
Bully Pulpit International
Remote, United States
- $180,000 to $225,000 USD / year
Bully Pulpit International is an outcomes agency made up of strategists, data scientists, and artists. We come from politics, brands, and government and we communicate without barriers and…
Added 3 mins ago
BP
Sr. Director/Managing Director, Paid Media + Partnerships
Bully Pulpit International
Remote, United States
- $180,000 to $225,000 USD / year
Bully Pulpit International is an outcomes agency made up of strategists, data scientists, and artists. We come from politics, brands, and government and we communicate without barriers and…
Added 4 mins ago
District Manager
Mondelez Global LLC
Remote, United States
Plan for Growth: Analyze sales data to identify trends, gaps, and opportunities for growth

SUN Behavioral Columbus

Utilization Management Specialist I

Columbus, OH, United States

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Job details

Apply by: Dec 31, 2026
Education: High school diploma
Posting language: English
Posted: Nov 13, 2026

Original job description

Position Summary:

Responsible for the coordination of case management strategies pursuant to the Case Management process. Assists and coordinates care of the patient from pre-hospitalization through discharges. Responsible for assisting with authorization of admissions to hospital. Processes retroactive reviews and appeals, copies needed documentation and writes retro/appeal letters for insurance companies to ensure coverage for patient admissions. Conducts follow up calls with insurance companies to ensure coverage for patient admissions. Participates in performance improvement activities. Attends 80% of staff meetings. Coordinates care for patient through communication with Physicians, Nurse Practitioners, Clinical Services, Nursing, Assessment and Referrals Department.

Position Responsibilities:

Clinical / Technical Skills (40% of performance review)

Provides thorough documentation and timely updates regarding patient status on log sheets that are prepared for daily meetings concerning admissions, reviews and discharges; including case s with limited benefits, cases in peer review/denial and /or unplanned discharges
Coordinates with managed care companies or other third-party payors regarding peer reviews, retrospective reviews and appeals. Document s and updates the denial log to reflect same.
Consults Business Office and/or admission staff as needed to clarify data and ensure authorization processes are complete.
Documents in HCS the results of admission and concurrent reviews.
Stays informed about changes in Medicare and Medicaid.
Ability to stage local laws, ordinances and practices governing involuntary hospitalization and ensure compliance with same.
Reviews the quality of documentation for each level of care to ensure clinical effectiveness and appropriateness of treatment.
Maintains an active involvement and awareness of all patient admissions, discharges and transfers to alternate levels of care. Oversees continuity of care for each level of care transition.
Develops and maintains processes to minimize denials and communication of same to CFO and Business Office Director.
Reports results of daily treatment team meetings all discharges and status of high-risk case such as limited benefits, peer reviews, denials or unplanned discharges.
Timely retroactive reviews and appeals within current month
Strong knowledge of external review organizations (i.e.: Medicare/Managed Care/Medicaid) with knowledge of payor resources and planning.
Types and mails all correspondence in a timely manner.
Answers the telephone in a polite manner, Communicates information to the appropriate staff.
Interacts with patients/families in a professional manner. Provides explanations regarding statements, insurance coverage.
Support discharge planning and utilization review when necessary
Perform other duties as required

Safety (15% of performance review)

Strives to create a safe, healing environment for patients and family members
Follows all safety rules while on the job.
Reports near misses, as well as errors and accidents promptly.
Corrects minor safety hazards.
Communicates with peers and management regarding any hazards identified in the workplace.
Attends all required safety programs and understands responsibilities related to general, department, and job specific safety.
Participates in quality projects, as assigned, and supports quality initiatives.
Supports and maintains a culture of safety and quality.

Teamwork (15% of performance review)

Works well with others in a spirit of teamwork and cooperation.
Responds willingly to colleagues and serves as an active part of the hospital team.
Builds collaborative relationships with patients, families, staff, and physicians.
The ability to retrieve, communicate, and present data and information both verbally and in writing as required
Demonstrates listening skills and the ability to express or exchange ideas by means of the spoken and written word.
Demonstrates adequate skills in all forms of communication.
Adheres to the Standards of Behavior

Integrity (15% of performance review)

Strives to always do the right thing for the patient, coworkers, and the hospital
Adheres to established standards, policies, procedures, protocols, and laws.
Applies the Mission and Values of SUN Behavioral Health to personal practice and commits to service excellence.
Supports and demonstrates fiscal responsibility through supply usage, ordering of supplies, and conservation of facility resources.
Completes required trainings within defined time periods, as established by job description, policies, or hospital leadership
Exemplifies professionalism through good attendance and positive attitude, at all times.
Maintains confidentiality of patient and staff information, following HIPAA and other privacy laws.
Ensures proper documentation in all position activities, following federal and state guidelines.

Compassion (15% of performance review)

Demonstrates accountability for ensuring the highest quality patient care for patients.
Willingness to be accepting of those in need, and to extend a helping hand
Desire to go above and beyond for others
Understanding and accepting of cultural diversity and differences

Qualifications

Education

Required: High school diploma or GED. CPR and hospital-selected de-escalation technique certification.
Preferred: Associates or Bachelors degree.
Maintains education and development appropriate for position.
May substitute experience for education

Experience

Required: One year of experience in a behavioral healthcare setting.
Preferred: Previous experience in a Utilization Management department or as a Mental Health Tech
May substitute education for experience

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Jobs in the United States