Care Utilization & Authorization Specialist

St.Vincent's Hospital Westchester; Town/Village of Harrison (NY); On-site; USD 55,000 - 75,000; Full time

Job summary

St. Vincent's Hospital Westchester is seeking an Utilization Review Specialist to bridge inpatient and ambulatory services with managed care organizations. The role emphasizes coordinating prior authorizations, documenting medical necessity, and monitoring patient benefits.

You will collaborate with inpatient and outpatient teams, Evaluation and Referral, Benefits, and Patient Accounts to ensure accurate and timely reviews and adherence to SJMC contractual agreements.

Qualifications

• One year experience in Healthcare and/or Managed Care Setting required.
• Undergraduate/Bachelor Degree in Human or Health Services preferred.

Responsibilities

• Act as liaison between inpatient/ambulatory services and managed care organizations.
• Obtain authorizations for all levels of care and perform medical necessity review.
• Monitor patient benefits and ensure compliance with SJMC contractual agreements; collaborate with multiple hospital departments.

Skills

Healthcare experience

Education

Bachelor's degree in Health/ Human Services

Job description

St. Vincent's Hospital Westchester is seeking an Utilization Review Specialist to bridge inpatient and ambulatory services with managed care organizations. The role emphasizes coordinating prior authorizations, documenting medical necessity, and monitoring patient benefits.

You will collaborate with inpatient and outpatient teams, Evaluation and Referral, Benefits, and Patient Accounts to ensure accurate and timely reviews and adherence to SJMC contractual agreements.