Utilization Review Specialist

UTILIZATION REVIEW POSITION

Centralized staff located at Innovation Center in Bossier.

Licensed (RN, LPN, MA) Positions Available

The primary responsibility of Utilization Review is to review medical records and prepare clinical appeals (when appropriate) on medical necessity, level of care, length of stay, and authorization denials for hospitalized patients.

An understanding of the severity of an array illnesses, intensity of service, and care coordination needs are key, as the individual must integrate clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient.

Utilization Review personnel work with the multidisciplinary team to assess and improve the denial management, documentation, and appeals process of such findings.

This employee will work with the Case Managers to ensure that the hospital renders quality care in a cost effective manner within the reimbursement guidelines. This employee is responsible for providing plans of care, orders, a summary, and extended stay reviews to Medicare, Medicaid, and private insurance companies requesting this on their insured patients.

The Utilization Management Program promotes the appropriate allocation of hospital's resources and quality care for each patient based upon each patient's identified needs and involvement in their care decisions.



QUALIFICATIONS:

Recommended - RN, LPN, or MA

Qualified Non-licensed healthcare professionals may apply as well

2 to 3 years clinical experience

Utilization Review, Case Management, or Revenue Cycle experience desirable, but not mandatory.

Available Shifts: 7:30a-4p