Utilization Review Specialist

4 weeks ago

Reno, United States Reno Behavioral Healthcare Hospital Full time

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 coordination, 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

Requirements

+ Bachelor's degree in Social Work or related field required.

+ Clinical Licensure in the State of Nevada preferred, no 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

We proudly offer the following benefits available first of the month following just one month of employment:

+ Competitive rates

+ Flexible schedules

+ Tuition reimbursement

+ Comprehensive package of benefits to include:

+ Medical

+ Dental

+ Vision

+ Life, Pet, Identity Theft Insurance

+ 401k

+ Generous paid time off

+ Short Term and Long Term Disability

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