Healthcare Utilization Review Expert

Bradford Health Services; Lucedale (MS); Sur place; USD 60 000 - 90 000; Plein temps

Avantages offerts par ce poste

Medical Coverage

401(k) Plan

Paid Time Off

Telehealth options

Dental Insurance

Résumé du poste

Bradford Health Services is seeking a dedicated Utilization Review Specialist to assess the medical necessity, efficiency, and regulatory compliance of patient care across the United States. You will review records, treatment plans, and data to inform approvals and optimize outcomes.

You will collaborate with healthcare providers, insurers, and case managers to ensure timely authorizations, maintain thorough documentation, and stay current with payer policies and evolving regulations.

Qualifications

• Bachelor’s degree in a healthcare or related field.
• At least 2 years of experience in utilization review, case management, or clinical healthcare roles.
• Strong knowledge of medical terminology, clinical procedures, and healthcare regulations.
• Familiarity with insurance authorization processes and healthcare reimbursement models.
• Excellent analytical, communication, and organizational skills.

Responsabilités

• Review and analyze medical records, treatment plans, and clinical documentation to assess necessity and appropriateness of services.
• Coordinate with healthcare providers, insurance representatives, and case managers to obtain additional information.
• Make informed decisions regarding authorization, continuation, modification, or denial of services based on guidelines.
• Maintain accurate records of utilization review activities in compliance with policies and legal standards.
• Stay current with evolving healthcare regulations, payer policies, and clinical best practices.

Connaissances

Analytical skills

Communication skills

Organizational skills

Formation

Bachelor's degree in healthcare or related field

Outils

EHR systems

Utilization management software

Description du poste

Bradford Health Services is seeking a dedicated Utilization Review Specialist to assess the medical necessity, efficiency, and regulatory compliance of patient care across the United States. You will review records, treatment plans, and data to inform approvals and optimize outcomes.

You will collaborate with healthcare providers, insurers, and case managers to ensure timely authorizations, maintain thorough documentation, and stay current with payer policies and evolving regulations.