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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

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