Utilization Review Specialist

3 weeks 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. As a key member of our healthcare team, you will play a critical role in ensuring that our patients receive the highest quality care while optimizing third-party payment for services.

Key Responsibilities
  • Review and Assess Patient Admission/Continued Stay: Utilize your expertise to review and assess the appropriateness of patient admission and continued stay, ensuring that our patients receive the necessary care while minimizing unnecessary costs.
  • Collaborate with Financial Case Management Representatives: Work closely with our Financial Case Management Representatives to monitor the use of insurance benefits and maximize service to our patients.
  • Provide Timely Insurance Benefits Information: Provide timely and pertinent insurance benefits information to our clinical staff, enabling them to provide care within our patients' benefits package and optimize third-party payment for services.
  • Assist Physicians with Appeals: Assist our physicians in preparing appeals when payment has been denied by insurance companies.
  • Implement Hospital Utilization Review Plan: Assist in the implementation of our Hospital Utilization Review Plan, ensuring that our patients receive the highest quality care while minimizing unnecessary costs.
  • Provide Consultation and Education: Provide consultation and education to our clinical staff regarding monitoring studies and medical records reviews.
  • Represent Hospital in Involuntary Hearings: Represent our hospital in involuntary hearings, ensuring that our patients receive the necessary care while minimizing unnecessary costs.
  • Participate in Clinical Committees: Serve as a member of various clinical committees, providing staff support to committee chairpersons.
Requirements
  • Bachelor's Degree: Bachelor's degree from an accredited institution in nursing, allied health, records administration, or a closely related field.
  • Related Experience: 2 years of related experience, with comprehensive knowledge of patient medical records, health insurance provisions, psychiatric diagnoses, and utilization review practices.
  • Strong Interpersonal and Analytical Skills: Strong interpersonal and analytical skills, with the ability to work effectively in a fast-paced environment.


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