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Utilization Review Specialist
2 months ago
The UR Specialist reviews and monitors patients’ utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties include providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency of medical services and procedures.
- Performs concurrent and retrospective reviews on all patients. Monitors level and quality of care.
- Responsible for the proactive management of patients with the objective of improving quality outcomes and decreasing costs.
- Evaluates and provides feedback to treating physicians regarding a patient’s discharge plans and available covered services, including identifying alternative levels of care that may be covered.
- Monitors all utilization reports to assure compliance with reporting and turnaround times.
- Addresses care issues with the Director of Clinical Services and Chief Medical Officer/Medical Director as appropriate.
- Coordinates an interdisciplinary approach to support continuity of care.
- Provides utilization management, transfer coordnation, discharge planning, and issuance of all appropriate authorization for covered services as needed.
- Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
- Clarifies health plan medical benefits, policies and procedures for members, physicians, staff, contract providers, and outside agencies.
Requirements
- Current LPN, RN or other Clinical Licensure and/or Master’s degree required.
- Knowledge of medical terminology, medical records, and appropriate medical coding system.
- Working knowledge with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint).
- Maintains confidentiality of patients at all times.
Benefits
A full benefits package is available the first of the month following just one (1) month of employment
Desert Parkway offers competitive benefits to include:
- Medical insurance (three plans to choose from)
- Dental insurance (two plans to choose from)
- Vision insurance
- 401K Retirement Plan
- Healthcare spending account
- Dependent care spending account
- PTO Plan
- Discounted cafeteria meal plan
- Life insurance (including plans for spouse and children)
- Short- and long-term disability (with additional buy-in opportunities)
- Pet Insurance
- Identity Theft Insurance
