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Utilization Review Specialist
1 week ago
Reno Behavioral Healthcare Hospital Reno, United StatesThe 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 medi ...
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Utilization Review Specialist
1 week ago
Renobehavioral Reno, United StatesThe 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 medic ...
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Utilization Review Specialist
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RN Staff Development Coordinator
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Court Specialist
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RN Staff Development Coordinator
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Insurance and Claims Specialist
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Clinical Pharmacist_Ambulatory Care
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Configuration Management Specialist
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Utilization Review Specialist - Reno, United States - Renobehavioral
Description
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 andretrospective 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 patient's 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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