Utilization Review Specialist

Company: Desert Parkway Behavioral Healthcare Hospital
Location: Las Vegas
Posted on: April 9, 2021

Job Description:

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. Eligible for benefits 1st of the month following 30-days of employment. Desert Parkway offers competitive benefits to include:
    • Health insurance
    • Vision insurance
    • 401K Retirement Plan
    • Healthcare spending account
    • Dependent care spending account
    • PTO Plan with holiday premium pay
    • Discounted cafeteria meal plan
    • Life insurance (Supplemental Life, Term and Universal plans are also available)
    • Short- and long-term disability (with additional buy-in opportunities)

Keywords: Desert Parkway Behavioral Healthcare Hospital, Las Vegas , Utilization Review Specialist, Other , Las Vegas, Nevada