Care-Focused Utilization Review Specialist

Memorial Physician Practices; Denver (CO); On-site; USD 35,817 - 45,460; Full time

Benefits offered by this job

Comprehensive Benefits

Financial Protection & PTO

Financial & Career Growth

Employee Well-being

Professional Development

Job summary

Denver Springs Hospital is seeking an on-site Utilization Review Specialist in Englewood, CO. You will analyze admissions and stays, interface with managed care, and advocate for timely coverage to ensure appropriate care.

The role emphasizes collaboration with the care team, clinical criteria knowledge, and ensuring insurance requirements are met for continued stay and discharge planning.

Qualifications

• Bachelor's degree required; master's preferred.
• Experience in utilization review or related field.
• Knowledge of inpatient and outpatient authorization processes.

Responsibilities

• Review admissions and continued stays to determine authorization needs.
• Advocate for patient coverage with managed care organizations.
• Coordinate with care teams to obtain necessary information for approvals.

Skills

Clinical criteria knowledge

Managed care coordination

Interdisciplinary communication

Education

Bachelor's degree

Master's degree preferred

Job description

Denver Springs Hospital is seeking an on-site Utilization Review Specialist in Englewood, CO. You will analyze admissions and stays, interface with managed care, and advocate for timely coverage to ensure appropriate care.

The role emphasizes collaboration with the care team, clinical criteria knowledge, and ensuring insurance requirements are met for continued stay and discharge planning.