Utilization Review Technician 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 Technician 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 Technician consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). The Utilization Review Technician gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Utilization Review Technician typically requires 2 to 4 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.
Requirements:
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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