Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)
The Utilization Review Specialist is responsible for organizing and conducting concurrent reviews with all insurance carriers. Daily task are (but not limited to): Conducting prior authorizations and continued stay reviews with insurances while utilizing ASAM criteria to determine medical necessity for each level of care in time allotted. UR Specialist will work closely with clinical teams and medical staff to minimize denials and facilitate optimal use of facility resources.
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Skills, knowledge, and abilities required:
Qualifications
The Utilization Review Specialist will Collaborate with BriteLife facilities regarding Utilization Review (UR) and ensures that all clients are authorized for treatment at the appropriate level of care in a timely manner. The UR Specialist serves a dual function ensuring quality and comprehensive charting of all services rendered by maintaining collaborative lines of communication with facility leadership.
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