Utilization Review Specialist

4 weeks ago

Lockhart, Florida, United States Plum Creek Recovery Ranch Full time
Job Summary

We are seeking a highly skilled Utilization Review Coordinator to join our team at Plum Creek Recovery Ranch. As a key member of our healthcare team, you will be responsible for conducting thorough utilization reviews to ensure patients receive appropriate care for their condition.

Key Responsibilities
  • Conduct utilization reviews to determine the appropriateness of patient care and treatment plans.
  • Monitor patient charts and records to evaluate care concurrent with treatment.
  • Review treatment plans and status of approvals from insurers.
  • Ensure adherence to the hospital's utilization review plan to optimize the use of hospital services.
  • Monitor the appropriateness of hospital admissions and extended hospital stays.
  • Collect and analyze data on demographics, claims, and medical information.
  • Consult with staff as needed to ensure effective care coordination.
Requirements
  • High School degree or equivalent required; Bachelor's degree preferred.
  • 3-5 years of experience in Admitting or Financial Counseling preferred.
  • Excellent problem-solving, critical thinking, and communication skills.
  • Ability to maintain a professional demeanor in high-stress environments.
  • Empathy and exceptional customer service skills.
  • Ability to manage multiple priorities and maintain confidentiality.
  • Basic computer skills and Microsoft Office proficiency.
Benefits
  • Health Insurance
  • Vision Insurance
  • Dental Insurance
  • 401K Retirement Plan
  • Healthcare Spending Account
  • Dependent Care Spending Account
  • PTO Plan with Holiday Premium Pay
  • Life Insurance
  • Short and Long-Term Disability

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