Utilization Review Specialist

Job Summary

A company is looking for a UR Queue Specialist.

Key Responsibilities

• Manage overflow cases and evaluate patient medical records for service necessity and appropriateness
• Analyze utilization data and communicate with providers and insurance companies to resolve issues
• Ensure compliance with regulatory requirements and maintain accurate records of reviews and decisions

Required Qualifications

• Minimum of one year experience in utilization review
• Experience in healthcare, particularly in behavioral health
• Familiarity with billing and EMR/EHR software
• Knowledge of medical necessity criteria and levels of care
• Ability to manage multiple tasks and prioritize workload effectively