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)
Job Overview:
We are seeking a highly skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will be responsible for reviewing medical records and assessing the appropriateness and necessity of healthcare services provided to patients. Your role will be crucial in ensuring quality patient care and optimizing resource utilization.
Duties:
- Conduct comprehensive reviews of medical records to evaluate the medical necessity and efficiency of healthcare services
- Collaborate with healthcare providers to obtain additional information or clarification regarding patient care
- Analyze clinical documentation to ensure accurate representation of patient conditions and treatments
- Utilize industry standards, such as HEDIS, to assess the quality of care provided
- Apply knowledge of medical coding systems (e.g., DRG) to accurately assign appropriate codes for reimbursement purposes
- Collaborate with case managers and other healthcare professionals to develop effective care plans
- Participate in utilization management activities to monitor and control healthcare costs
- Maintain accurate and detailed documentation of all review activities
Experience:
- Valid nursing license
- Previous experience in utilization review, discharge planning, or a related field preferred
- Strong knowledge of medical documentation standards and guidelines
- Familiarity with utilization management principles and practices
- Proficiency in using electronic health record (EHR) systems, such as Athenahealth
- Experience working in acute care settings is highly desirable
- Knowledge of hospice care is a plus
- Excellent analytical and critical thinking skills
Job Type: Full-time
Pay: $1.00 - $1.50 per hour
Benefits:
Schedule:
Ability to Relocate:
Work Location: In person
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