Utilization Review Specialist

3 hours ago


San Diego, California, United States Aurora San Diego Full time
Job Summary

Aurora San Diego is seeking a skilled Utilization Review Specialist to join our team. As a key member of our multi-disciplinary treatment team, you will play a critical role in reviewing patient care and treatment options for both inpatient and outpatient services.

Key Responsibilities:

  • Conduct admission reviews to ensure accurate and efficient patient care
  • Perform concurrent and extended stay reviews to optimize reimbursement and patient outcomes
  • Prepare and submit appeals to third-party payers to resolve reimbursement disputes
  • Maintain accurate and up-to-date records of the Utilization Review Department
  • Provide in-service training and education to staff members
  • Ensure confidentiality of patient information at all times
  • Develop strong relationships with patients, families, and healthcare providers to ensure seamless care coordination
  • Stay up-to-date with industry developments and best practices in healthcare utilization review

Requirements:

  • Preferred: Current license as RN, LVN/LPT, LCSW
  • Preferred: Master's degree in Social Work, Behavioral Science, or related field
  • BLS (Basic Life Support) Certification for Healthcare Providers following the American Heart Association guidelines

Benefits:

  • 401K Retirement Plan
  • Health Insurance
  • Vision Insurance
  • Dental Insurance
  • Pet Insurance
  • Healthcare Spending Account & Dependent Care Spending Account
  • Life Insurance (Supplemental Life, Term, and Universal plans are also available.)
  • PTO Plan with Holiday Premium Pay
  • PTO Cash Out option
  • Sick Pay
  • Short and Long-Term Disability (with additional buy-in opportunities)
  • Tuition Reimbursement
  • Employee Assistance Program
  • ID Theft Protection


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