Utilization Review Specialist

10 hours ago


Towson, Maryland, United States Sheppard Pratt Full time
Job Summary

We are seeking a highly skilled Utilization Review Coordinator to join our team at Sheppard Pratt. The successful candidate will be responsible for reviewing and assessing the appropriateness of patient admissions and continued stays, working with financial case management representatives to monitor insurance benefits, and providing timely and pertinent insurance benefits information to clinical staff.

Key Responsibilities
  • Review and assess patient admissions and continued stays to ensure appropriateness and maximize insurance benefits.
  • Collaborate with financial case management representatives to monitor insurance benefits and optimize service to patients.
  • Provide timely and pertinent insurance benefits information to clinical staff to ensure they provide care within patients' benefits package.
  • Assist physicians in preparing appeals for denied insurance payments.
  • Implement the Hospital Utilization Review Plan and provide consultation and education to clinical staff on monitoring studies and medical records reviews.
  • Represent the hospital in involuntary hearings and serve as a member of various clinical committees.
Requirements
  • Bachelor's degree in nursing, allied health, records administration, or a closely related field.
  • Two to three years of related experience in patient medical records, health insurance provisions, psychiatric diagnoses, and utilization review practices.


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