Utilization Review Specialist

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.

Benefits

A full benefits package is available the first of the month following just one (1) month of employment!

Desert Parkway offers competitive benefits to include:

• Medical insurance (three plans to choose from)
• Dental insurance (two plans to choose from)
• Vision insurance
• 401K Retirement Plan
• Healthcare spending account
• Dependent care spending account
• PTO Plan
• Discounted cafeteria meal plan
• Life insurance (including plans for spouse and children)
• Short- and long-term disability (with additional buy-in opportunities)
• Pet Insurance
• Identity Theft Insurance