Utilization Review Specialist

Position Title: Utilization Review Specialist (Remote)

Location: Remote (Candidates must have a reliable internet connection and a suitable home office setup.)

Job Description:
As a Utilization Review Specialist, you will play a critical role in ensuring the quality and appropriateness of healthcare services provided to our patients. This remote position involves evaluating medical records, treatment plans, and insurance coverage to determine the necessity and efficiency of healthcare services.

Responsibilities:

• Evaluate patient medical records to assess the appropriateness and quality of care provided.
• Verify the accuracy and completeness of documentation to support medical necessity.
• Analyze treatment plans and interventions to ensure they align with patient needs and best practices.
• Collaborate with healthcare providers to make recommendations for adjustments or improvements in treatment plans.
• Verify insurance coverage and benefits to determine eligibility for services.
• Communicate with insurance providers to obtain authorization for services as needed.
• Conduct Utilization Reviews to monitor and optimize the use of healthcare resources.
• Identify and address any utilization patterns that may indicate inefficiencies or deviations from standards of care.
• Maintain accurate and detailed records of Utilization Review activities and outcomes.
• Prepare reports and summaries of findings for internal review and compliance purposes.

Qualifications:

• Education: Bachelor's degree in healthcare administration, nursing, or related field (preferred).
• Experience: Minimum of 1 year of experience in Utilization Review or a similar role.
• Certifications: Certified Professional in Utilization Review (CPUR) or similar certification (preferred).
• Attention to detail; Excellent communication and organizational skills.
• Knowledge of medical necessity criteria/ASAM/Regulatory requirements.
• Ability to multitask and prioritize workload effectively.
• Detailed documentation and record-keeping skills.
• Advocate quality care for patients and collaborate with QA team.

Team Values/Culture:

• Advocate for patients, educate with kindness, support teammates.
• Work with efficiency and accuracy to ensure optimal patient care.

Benefits:

• Competitive salary and benefits package.
• Health, dental, and vision insurance.
• Retirement savings plan.
• Continuing education opportunities.
• Employee assistance program.
• Opportunities for career advancement.
• Supportive and collaborative work environment.

This position offers the opportunity to contribute to the delivery of high-quality and cost-effective healthcare services while working remotely. If you have a passion for healthcare administration and ensuring optimal patient care, we encourage you to apply for this rewarding role as a Utilization Review Specialist.

Note:This job description is intended to provide a general overview of the position. Duties and responsibilities may be subject to change based on organizational needs and priorities.

Job Type: Full-time

Pay: $48,000.00 - $60,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Experience:

• Medical records: 1 year (Preferred)

Work Location: Remote