UR Specialist
UR Specialist
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Job Description
The Utilization Review Specialist will be providing first level initial admission and continued stay case reviews. The right candidate will assist in determining the appropriate cases for review by utilizing both client specific guidelines and clinical experience in collaboration with the medical and admissions team. Candidate will need to rely on utilizing clinical experience and skills in a collaborative process to assess plan implement coordinate monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. This is achieved by applying the appropriate clinical criteria/guideline policy procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. The right candidate communicates with providers to facilitate care/treatment.
Responsibilities:
- Assess members needs
- Performs inpatient utilization review and applies client guidelines as detailed in the client UM Plan for length of stay/admission criteria to approve initial and continued inpatient services.
- Identify solutions to problems and nonstandard requests
- Conducts UM review and discharge planning at the facility level
- Follows and maintains compliance with regulatory agency requirements
- Maintain courteous professional attitude
- Collaborate with staff physicians medical team admission coordinators members and their families to coordinate and provide the level of care necessary to meet members need.
- Ensure that appropriate clinical documentation is in place
- Abstract data from a variety of medical records to ensure accurate clinical data
- Participates in treatment team meetings and clinical pass on.
- Generating Appeals to support client care and assist billing office with claims payments.
Requirements:
- Ensure effective communication skills both verbal and written. Effectively communicates in a timely manner to management and internal departments. Providing Internally/externally excellent customer service.
- Proficient in MS Office Applications and ability to learn department and job specific software systems. Position requires proficiency with computer skills which includes navigating multiple systems
- Perform other duties as assigned by departmental leadership in support of departmental and organizational strategies and goals which may include: system testing training and other opportunities that promote growth
- Complete and maintain annual compliance and annual HIPAA training
- Indepth knowledge of current standard of medical practices and insurance benefit structures.
- Knowledge and competency in all types of medicalnecessity decisions including inpatient care subacute and outpatient care.
Compensation for roles at Azure Acres varies depending on a wide array of factors including but not limited to the specific location role skill set and level of experience.As required by local law Azure Acres provides a reasonable hourly range of compensation for roles that may be hired in California set forth below.
Role Location: Sebastopol California
Calculated Hourly Range for role: California: $26.00 $31.00 per hour
- Participate in organizational educational offerings and required training as needed to support service delivery.
- Excellent analyticalthinking/problemsolving skills.
- The ability to work effectively in a fastpaced environment with frequently changing priorities deadlines and workloads with the ability to switch priorities in a positive and effective manner when directed by leadership with the ability to work independently with limited supervision.
- The ability to offer positive customer service to every internal and external customer including challenging personalities.
- Excellent oral and written interpersonal/communication internal/external customerservice organizational multitasking and teamwork skills.
Compensation for roles at Azure Acres varies depending on a wide array of factors including but not limited to the specific location role skill set and level of experience.As required by local law Azure Acres provides a reasonable hourly range of compensation for roles that may be hired in California set forth below.
Role Location: Sebastopol California
Calculated Hourly Range for role: California: $26.00 $31.00 per hour
Required Experience:
Unclear Seniority
Employment Type
Full-Time
