Utilization Review Specialist
Desert Parkway Behavioral Healthcare Hospital
Las Vegas, 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. ...