State Licensed Utilization Review Specialist

Job Summary

A company is looking for a Utilization Review Specialist.

Key Responsibilities

• Perform admission and continued stay reviews to determine medical necessity and maintain documentation
• Facilitate interactions between medical center personnel and payers to address potential denials and ensure reimbursement
• Assist in maintaining compliance with regulatory standards and serve as an educational resource for staff

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