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Utilization Review (UR) Specialist

Company: Lifeskills South Florida
Location: Deerfield Beach
Posted on: May 5, 2022

Job Description:

Lifeskills South Florida is in search of a Utilization Review SpecialistUtilization Review (UR) Specialist are responsible for monitoring the effective and efficient use of health care resources by review of patient admission and continued stay appropriateness. UR Coordinators interact with outside agencies, third party payer and managed care companies in accordance with contractual agreements, acting as a patient advocate and a representative of the hospital.
Position Responsibilities Include:

  • Setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  • Conducts initial pre-certification authorizations, continued stay reviews, care coordination, and discharge planning for appropriateness of treatment.
  • Assesses the medical necessity of client appropriateness of treatment setting to determine the level of care required.
  • Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required.
  • Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, care throughout the medical management process.
  • Utilizes the applicable documentation methods needed to communicate effectively with the medical and clinical team(s).
  • Provides staff with appropriate providers, programs, or community resources.
  • Collaborates with providers to assess members' needs for early identification of and proactive discharge planning.
  • Facilitates Peer Reviews when needed.
    ISJP123
    Education and Experience:Position requires a Bachelor's degree and 1 year clinical experience in a mental health facility setting.

Keywords: Lifeskills South Florida, Deerfield Beach , Utilization Review (UR) Specialist, Other , Deerfield Beach, Florida

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