Utilization Review Specialist

5 days ago


Arizona City, Arizona, United States Summit BHC Full time
Job Title: Utilization Review Specialist

Canyon Vista Recovery Center is seeking a skilled Utilization Review Specialist to join our team. As a Utilization Review Specialist, you will play a critical role in ensuring that our patients receive the necessary care and services to achieve optimal outcomes.

Key Responsibilities:
  • Conduct thorough reviews of patient admissions, continued stays, and discharges to ensure medical necessity and compliance with regulatory requirements.
  • Communicate effectively with insurance companies, health maintenance organizations (HMOs), and other payers to obtain authorizations and resolve denials.
  • Collaborate with healthcare providers to ensure accurate and timely documentation of patient information.
  • Develop and maintain accurate and comprehensive records of patient information, including medical history, treatment plans, and outcomes.
  • Participate in quality improvement initiatives to enhance patient care and reduce costs.
Requirements:
  • Bachelor's degree in a related field, such as nursing, social work, or healthcare administration.
  • One or more years of experience in a healthcare setting, preferably in utilization review or a related field.
  • Strong analytical and problem-solving skills, with the ability to interpret complex data and make informed decisions.
  • Excellent communication and interpersonal skills, with the ability to work effectively with healthcare providers, payers, and other stakeholders.
Why Join Our Team?

Canyon Vista Recovery Center offers a comprehensive benefits package, including medical, dental, and vision insurance, as well as a 401(k) plan and paid time off. We are committed to providing a supportive and inclusive work environment that fosters professional growth and development.



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