Healthcare Utilization Review Specialist

3 days ago


Detroit, Michigan, United States Detroit Medical Center Full time
About Detroit Medical Center

The Detroit Medical Center (DMC) is a leading healthcare provider in Southeast Michigan, renowned for its academic excellence and commitment to patient care. With a rich 150-year history, the DMC operates eight hospitals and over 140 clinics, offering a wide range of services from cardiovascular health to pediatrics.

Job Summary

We are seeking an experienced Healthcare Utilization Review Specialist to join our team. As a key member of our utilization review department, you will play a crucial role in ensuring that patients receive the most appropriate level of care, balancing clinical needs with financial requirements.

Key Responsibilities:
  • Balancing clinical and financial considerations to advocate for patient needs while managing resources judiciously.
  • Promoting prudent utilization of all resources, including fiscal, human, environmental, equipment, and services.
  • Completing admission reviews for all payors, sending admission reviews to payors with an authorization process.
  • Conducting concurrent reviews for all payors, sending concurrent reviews to payors with an authorization process.
  • Closing open cases on the incomplete UM Census.
  • Ensuring compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy.
Requirements:
  • Experience in healthcare utilization review or a related field.
  • Strong knowledge of medical necessity principles and payer regulations.
  • Excellent communication and problem-solving skills.
  • Ability to work in a fast-paced environment and prioritize tasks effectively.
Benefits:
  • A competitive salary of approximately $80,000 - $110,000 per year, depending on experience.
  • A comprehensive benefits package, including medical, dental, vision, and life insurance.
  • Retirement savings plan and employee assistance program.
  • Opportunities for professional growth and development.
Why Work at Detroit Medical Center?

At the DMC, we value our employees and offer a supportive work environment, opportunities for advancement, and a chance to make a meaningful difference in the lives of our patients and their families. Join our team and become part of a legacy of caring and compassion.



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