Remote Utilization Review Specialist

Major Hospital; Shelbyville (IN); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Major Hospital in the United States is seeking a skilled utilization review professional to review medical records for necessity and appropriateness of care. You will collaborate with providers, staff, insurers, and case managers to ensure patients receive the right level of care per industry standards.

The role requires several years of clinical experience and proficiency with healthcare information systems, with PRN status on Integrated Case Management and weekend/evening variances.

Qualifications

• Several years of experience in a clinical setting.
• Experience with healthcare information systems and software.

Responsibilities

• Review and evaluate medical records for necessity and appropriateness of services.
• Collaborate with healthcare providers, clinical staff, case managers, insurance companies, clinical coders and patient access staff to ensure appropriate level of care.
• Interpret data and identify trends to support utilization review.
• Maintain confidentiality and adhere to regulatory standards.

Skills

Clinical experience

Healthcare IT systems

Education

Bachelor's degree in nursing, healthcare management, or related field

Job description

Major Hospital in the United States is seeking a skilled utilization review professional to review medical records for necessity and appropriateness of care. You will collaborate with providers, staff, insurers, and case managers to ensure patients receive the right level of care per industry standards.

The role requires several years of clinical experience and proficiency with healthcare information systems, with PRN status on Integrated Case Management and weekend/evening variances.