Utilization Review Specialist in Nevada

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.
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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...