Utilization Review Specialist Job at Reno Behavioral Healthcare Hospital, Reno, NV

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  • Reno Behavioral Healthcare Hospital
  • Reno, NV

Job Description

The UR Specialist reviews and monitors patients’ utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties include providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency of medical services and procedures.

  • Performs concurrent and retrospective reviews on all patients. Monitors level and quality of care.
  • Responsible for the proactive management of patients with the objective of improving quality outcomes and decreasing costs.
  • Evaluates and provides feedback to treating physicians regarding a patient’s discharge plans and available covered services, including identifying alternative levels of care that may be covered.
  • Monitors all utilization reports to assure compliance with reporting and turnaround times.
  • Addresses care issues with the Director of Clinical Services and Chief Medical Officer/Medical Director as appropriate.
  • Coordinates an interdisciplinary approach to support continuity of care.
  • Provides utilization management, transfer coordination, discharge planning, and issuance of all appropriate authorization for covered services as needed.
  • Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
  • Clarifies health plan medical benefits, policies and procedures for members, physicians, staff, contract providers, and outside agencies.

Requirements

Requirements

  • Bachelor's degree in Social Work or related field required.
  • Clinical Licensure in the State of Nevada preferred, no required
  • Knowledge of medical terminology, medical records, and appropriate medical coding system.
  • Working knowledge with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint).
  • Maintains confidentiality of patients at all times.

Benefits

We proudly offer the following benefits available first of the month following just one month of employment:

  • Competitive rates
  • Flexible schedules
  • Tuition reimbursement
  • Comprehensive package of benefits to include:
    • Medical
    • Dental
    • Vision
  • Life, Pet, Identity Theft Insurance
  • 401k
  • Generous paid time off
  • Short Term and Long Term Disability

Job Tags

Full time, Contract work, Temporary work, Flexible hours,

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