Utilization Review Specialist

Sharon, PA; Sharon (Mercer County); On-site; USD 65,000 - 85,000; Full time

Job summary

Sharon, PA is looking for a Utilization Review Specialist to enhance our healthcare team. This role focuses on securing treatment authorization and ensuring all relevant documentation is accurate and complete. The UR Specialist collaborates with medical staff to provide exceptional patient care.

Qualified candidates must possess a valid RN license and have at least 2 years of experience. Strong communication and organizational skills are essential for success in this position.

Qualifications

• Valid RN license in the state of practice.
• Familiarity with HIPAA regulations and patient confidentiality protocols.
• Minimum of 2 years of relevant experience.

Responsibilities

• Secures authorization for treatment payment from insurers.
• Maintains knowledge of coding and diagnostic standards.
• Ensures thorough documentation in medical records.

Skills

Excellent communication skills

Leadership skills

Organizational skills

Education

Valid Registered Nurse (RN) license

Minimum of 2 years’ experience

Job description

We are seeking a Utilization Review Specialist to join our healthcare team. The Utilization Review Specialist ensures that the appropriate authorization for treatment is secured, and that all pertinent clinical information is present to obtain this authorization. The UR Specialist works with the medical staff and the other members of the interdisciplinary team to assist in the delivery of quality care across the continuum. Planning for individual age-specific needs will occur as it relates to the assigned patient population. Documentation requirements are monitored by the UR Specialist.

Responsibilities

• Secures authorization for payment of services rendered from all types of primary and secondary insurers.
• Maintains knowledge of coding and diagnostic standards to ensure appropriate service utilization.
• Ensures the thoroughness of all documentation entered into the medical record.
• Additional duties to be discussed.

Qualifications

• Valid Registered Nurse (RN) license in the state of practice.
• Minimum of 2 years’ experience.
• Familiarity with HIPAA regulations and patient confidentiality protocols.
• Excellent communication skills, both verbal and written.
• Demonstrated leadership and organizational skills.

Join our team of healthcare professionals dedicated to making a difference in the lives of our patients!