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)
Position Summary:
The Utilization Review Specialist/Outcomes Specialist conducts concurrent and retrospective review functions in support of the hospital Utilization Review Program and makes appropriate referrals to designated Physician Advisors.
Education:
Holds a current Texas license as a Registered Nurse.
Training and Experience:
Three years clinical nursing experience in general medical/surgical setting or appropriate specialty area; at least one year in an acute care setting.
Job Knowledge:
Excellent verbal and written skills well rounded critical thinking skills, self-motivated, flexible, and goal oriented. Ability to tolerate frequent interruptions and demanding workload
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