Utilization Review Specialist

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
Current LPN, RN or other Clinical Licensure and/or Master’s degree 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.
Benefits
A full benefits package is available the first of the month following just one (1) month of employment!
Desert Parkway offers competitive benefits to include:
Medical insurance (three plans to choose from)
Dental insurance (two plans to choose from)
Vision insurance
401K Retirement Plan
Healthcare spending account
Dependent care spending account
PTO Plan
Discounted cafeteria meal plan
Life insurance (including plans for spouse and children)
Short- and long-term disability (with additional buy-in opportunities)
Pet Insurance
Identity Theft Insurance