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 Summary:
Responsible for reviewing medical records, preparing clinical appeals (when appropriate) on medical necessity, length of stay, and authorization denials for hospitalized patients. Utilization Review Manager will be responsible for compliance with CMS Conditions of Participation regarding Utilization Review and Discharge Planning and complies with hospital policies and procedures. Knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage. The Utilization Review Manager will practice improving quality through coordination of care impacting length of stay, minimizing cost, and ensuring optimum outcomes through
collaboration with CNO, Medical staff, and nursing staff.
Supervisory Responsibility:
None.
Position Qualifications:
Current, valid, and active LPN - Licensed Practical Nurse, BSN - Registered Nurse or LSW- Social Worker license in the state of employment required.
Current BLS certification required
Key Responsibilities / Job Accountabilities:
Additional Skills / Qualifications:
Clear All
0 Utilization Review Technician jobs found in Youngstown, OH area