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Clinical Utilization Review Specialist

3 months ago

Ambler, Alaska, United States UHS Full time
Job Title: Clinical Utilization Review Specialist

We are seeking a highly skilled Clinical Utilization Review Specialist to join our team at The Horsham Clinic. As a Clinical Utilization Review Specialist, you will play a critical role in evaluating medical records to determine the severity of patient illness and determining the appropriate level of care.

Responsibilities:
  • Evaluate medical records to determine the severity of patient illness and determine the appropriate level of care
  • Act as a liaison between patients and hospital with insurance companies
  • Negotiate and advocate for patients' length of stay and level of care
  • Oversee utilization review activities with other departments to ensure reimbursement for services provided by the hospital
Requirements:
  • Masters Level Education/ MSW
  • RN License in the state of Pennsylvania
  • Licensure in LSW/ LSCW
  • Experience in interviewing patients and families to obtain clinical information and acute symptoms
  • Highly developed written and verbal communication skills
  • 3 or more years of experience in behavioral health setting
  • Ability to plan, direct, and monitor others' activities with demonstrated leadership abilities that contribute to a positive work environment

We offer a competitive salary, excellent benefits, and a dynamic work environment. If you are passionate about delivering high-quality patient care and have a strong background in behavioral health, we encourage you to apply for this exciting opportunity.