Utilization Review Specialist-PRN
Utilization Review Specialist-PRN
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
- Act as liaison between managed care organizations and the facility professional clinical staff.
- Conduct reviews in accordance with certification requirements of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
- Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
- Gather and develop statistical and narrative information to report on utilization noncertified days (including identified causes and appeal information) discharges and quality of services as required by the facility leadership or corporate office.
- Conduct quality reviews for medical necessity and services provided.
- Facilitate peer review calls between facility and external organizations.
- Initiate and complete the formal appeal process for denied admissions or continued stay.
- Assist the admissions department with precertifications of care.
- Provide ongoing support and training for staff on documentation or charting requirements continued stay criteria and medical necessity updates.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
