Job 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 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 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 coordnation, 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.
- 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.
Benefits
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
Qualification
Bachelor's Degree
Key skill Required
- Microsoft Office
- Authorization
- Clinical Services
- Compliance
- Comprehensive
- Discharge Planning
- Identity Theft
- Insurance
- Licensure
- Management
- Medical Coding
- Medical Services
- Medical Terminology
- Policies and Procedures
- Proactive
- Proactive Management
- Reimbursement
- Reporting
- Social Work
- Utilization Management
