Utilization Review Specialist

3 weeks ago


Spencer, Iowa, United States CodeForce Full time
Utilization Review Specialist - Nursing

CodeForce is seeking a skilled Utilization Review Specialist to join our team. As a key member of our Nursing department, you will be responsible for reviewing patient care plans and ensuring they meet the necessary criteria for admission and continued stay.

Responsibilities:

  • Review medical records for clear admission orders and documentation of medical necessity
  • Perform utilization review activities for Medicare, Medicaid, Private insurance, and self-pay patients
  • Communicate with Patient Accounts on patient's level of care and insurance coverage
  • Enter insurance authorizations obtained into Paragon UR or Patient Management 'Notes' tab

Requirements:

  • Minimum 5 years of experience in direct patient care
  • Minimum 3 years in a Utilization Review role
  • Strong communication and organizational skills

We offer a competitive salary and benefits package. If you are a motivated and detail-oriented individual with a passion for healthcare, please submit your application.



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