Utilization Review Specialist

3 weeks ago


Reno, United States CareerBuilder Full time

The UR Specialist reviews and monitors patients utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties include providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency of medical services and procedures.
Performs concurrent and

retrospective reviews on all patients. Monitors level and quality of care.
Responsible for the

proactive management of patients with the objective of improving quality

outcomes and decreasing costs.
Evaluates and provides

feedback to treating physicians regarding a patients discharge plans and

available covered services, including identifying alternative levels of

care that may be covered.
Monitors all utilization

reports to assure compliance with reporting and turnaround times.
Addresses care issues with

the Director of Clinical Services and Chief Medical Officer/Medical

Director as appropriate.
Coordinates an

interdisciplinary approach to support continuity of care.
Provides utilization

management, transfer coordination, discharge planning, and issuance of all

appropriate authorization for covered services as needed.
Identifies and recommends

opportunities for cost savings and improving the quality of care across

the continuum.
Clarifies health plan

medical benefits, policies and procedures for members, physicians, staff,

contract providers, and outside agencies.
Requirements
Bachelor's degree in Social Work

or related field required.
Clinical Licensure in the

State of Nevada preferred, no required
Knowledge of medical

terminology, medical records, and appropriate medical coding system.
Working knowledge with

software and/or equipment (Microsoft Office applications including

Outlook, Word, Excel and PowerPoint).
Maintains confidentiality

of patients at all times.
We proudly offer the following benefits available first of the month following just one month of employment:
Competitive rates
Flexible schedules
Tuition reimbursement
Comprehensive package of

benefits to include:

Medical
Dental
Vision

Life, Pet, Identity Theft

Insurance
401k
Generous paid time off
Short Term and Long Term

Disability

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