Patient Care Specialist

2 days ago


Iowa City, Iowa, United States University of Iowa Full time
Responsibilities
* Perform admission, concurrent, and retrospective utilization management-related reviews and functions to track, evaluate, and report data.
* Utilize evidence-based clinical review screening criteria to support medical necessity determinations and refer cases to the Physician Advisor or appeal as necessary.
* Collaborate with the healthcare team to determine the appropriate hospital setting (inpatient vs. outpatient) based on medical necessity and actively seek additional clinical documentation from physicians to optimize reimbursement.
* Validate commercial payer authorization within contractual timeframes and manage concurrent cases to resolution.



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