Clinical Utilization Review Advocate

WESTCARE NEVADA INC; Henderson (NV); On-site; USD 65,000 - 90,000; Full time

Job summary

WestCare Nevada Inc. is seeking a Utilization Review professional to collect clinical information and advocate for appropriate patient care. You will communicate with MCOs/insurers to obtain approvals and ensure compliance with regulatory standards.

The role requires strong analytical skills, knowledge of CPT/ICD coding, EMR systems, and HIPAA guidance, with a focus on coordination across departments and accurate documentation.

Qualifications

• Associates or Bachelors level LPN or RN
• CADC/LADC with 2 years utilization review experience
• Experience with psychiatric or substance use disorder preferred

Responsibilities

• Establish and maintain positive and frequent communication with insurance carriers
• Read and understand patient narratives and case notes to determine patient needs and clinical recommendations
• Call in intakes and/or peers to obtain appropriate level of care authorization
• Obtain and communicate level of care and authorizations and enter information into systems
• Submit quality authorization documentation to insurance companies
• Advocate for patient care and benefits across levels of care
• Track current and concurrent authorization needs in all levels of care
• Document accounts clearly in the system and coordinate with other departments

Skills

Utilization review

Case conceptualization

CPT/ICD coding

HIPAA knowledge

EMR systems

Microsoft Office

Communication skills

Critical thinking

Team collaboration

Negotiation

Education

Associates or Bachelors RN/LPN

CADC/LADC with 2 years UR experience

Job description

WestCare Nevada Inc. is seeking a Utilization Review professional to collect clinical information and advocate for appropriate patient care. You will communicate with MCOs/insurers to obtain approvals and ensure compliance with regulatory standards.

The role requires strong analytical skills, knowledge of CPT/ICD coding, EMR systems, and HIPAA guidance, with a focus on coordination across departments and accurate documentation.