Utilization Review Specialist

Job Overview:
We are seeking a detail-oriented and experienced Utilization Review Specialist to join our Outpatient Behavioral Health Team. As a Utilization Review Specialist, you will be responsible for reviewing medical records and assessing the appropriateness and necessity of healthcare services. Your role will be crucial in ensuring that patients receive the most effective and efficient care possible.

Responsibilities:
- Review medical records to determine the medical necessity and appropriateness of requested services
- Conduct Utilization Reviews to evaluate the quality, cost-effectiveness, and efficiency of healthcare services
- Collaborate with healthcare providers to gather additional information or clarify documentation
- Utilize medical coding systems and terminology to accurately document findings and recommendations
- Communicate with insurance companies, healthcare providers, and patients to facilitate the authorization or denial of requested services
- Monitor patient outcomes and identify opportunities for improvement in care delivery
- Stay updated on industry regulations, guidelines, and best practices related to Utilization Review

Requirements:
-Proven experience as a Utilization Review Specialist or similar role
- Strong knowledge of medical office procedures, including medical terminology and medical records management
- Familiarity with Utilization Review processes and guidelines
- Excellent analytical and critical thinking skills
- Strong attention to detail and ability to work independently
- Effective communication skills, both written and verbal
- Ability to maintain confidentiality of patient information

Joining our team as a Utilization Review Specialist offers the opportunity to make a meaningful impact on patient care while working in a collaborative and supportive environment. We offer competitive compensation packages, ongoing professional development opportunities, and a positive work-life balance.

If you meet the requirements for this position and are passionate about delivering high-quality healthcare services, we encourage you to apply.

Job Types: Full-time, Part-time

Pay: $20.51 - $25.00 per hour

Benefits:

• Flexible schedule
• Paid time off

Schedule:

• 8 hour shift
• Monday to Friday

Ability to Relocate:

• Reno, NV 89502: Relocate before starting work (Required)

Work Location: Hybrid remote in Reno, NV 89502