Healthcare Utilization Review Specialist

Addiction-and-Mental-Health-Services,-LLC; Gulfport (MS); Sur place; USD 65 000 - 85 000; Plein temps

Avantages offerts par ce poste

Medical coverage

Retirement benefits

Generous PTO

Student loan repayment

EAP access

Résumé du poste

Bradford Health Services in Birmingham, AL is seeking a Utilization Review Specialist to evaluate patient records, treatment plans, and clinical data to determine necessity and appropriateness of care. You will collaborate with clinicians, insurers, and case managers to secure timely approvals while ensuring regulatory compliance.

The role requires a bachelor’s degree in healthcare or related field, 2+ years in utilization review or case management, and strong knowledge of medical terminology

Qualifications

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

Responsabilités

• Review medical records and clinical documentation to assess necessity and appropriateness of services.
• Coordinate with providers, insurers, and case managers to obtain information.
• Decide on authorization, continuation, modification, or denial of services based on guidelines.
• Maintain thorough records of utilization reviews and communications.
• Stay updated with evolving regulations and payer policies to ensure compliant review processes.

Connaissances

Analytical skills

Communication skills

Organizational skills

Regulatory knowledge

Formation

Bachelor’s degree in healthcare or related field

Description du poste

Bradford Health Services in Birmingham, AL is seeking a Utilization Review Specialist to evaluate patient records, treatment plans, and clinical data to determine necessity and appropriateness of care. You will collaborate with clinicians, insurers, and case managers to secure timely approvals while ensuring regulatory compliance.

The role requires a bachelor’s degree in healthcare or related field, 2+ years in utilization review or case management, and strong knowledge of medical terminology