Utilization Review (UR) Specialist
Company: Lifeskills South Florida
Location: Deerfield Beach
Posted on: May 5, 2022
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
Position Responsibilities Include:
- Setting reviews to ensure compliance with applicable criteria,
medical policy, and member eligibility, benefits, and
- 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
- Collaborates with providers to assess members' needs for early
identification of and proactive discharge planning.
- Facilitates Peer Reviews when needed.
Education and Experience:Position requires a Bachelor's degree and
1 year clinical experience in a mental health facility
Keywords: Lifeskills South Florida, Deerfield Beach , Utilization Review (UR) Specialist, Other , Deerfield Beach, Florida
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