Licensed Utilization Review Specialist
Job Summary
To support a growing Utilization Review team, the full-time Licensed Utilization Review Specialist will perform admission and continued stay reviews, manage the authorization process, and ensure compliance with regulatory standards while working remotely.
Key responsibilities
- Perform admission and continued stay reviews to determine medical necessity and document findings accurately
- Facilitate interactions between medical center personnel and payer personnel to address denials and obtain necessary authorizations
- Assist in maintaining compliance with JCAHO, Medicaid, Medicare, and other third-party payer standards
Required qualifications
- Bachelor's degree in a related field
- 2+ years of work experience in a related job discipline
- Current, unrestricted Registered Nurse (RN), Social Work, or Clinical Counselor Licensure in the state(s) of practice
Complete Job Description
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