Utilization Review Specialist

St.Vincent's Hospital Westchester; Town/Village of Harrison (NY); On-site; USD 55,000 - 75,000; Full time

Job summary

St. Vincent's Hospital Westchester is seeking an Utilization Review Specialist to bridge inpatient and ambulatory services with managed care organizations. The role emphasizes coordinating prior authorizations, documenting medical necessity, and monitoring patient benefits.

You will collaborate with inpatient and outpatient teams, Evaluation and Referral, Benefits, and Patient Accounts to ensure accurate and timely reviews and adherence to SJMC contractual agreements.

Qualifications

• One year experience in Healthcare and/or Managed Care Setting required.
• Undergraduate/Bachelor Degree in Human or Health Services preferred.

Responsibilities

• Act as liaison between inpatient/ambulatory services and managed care organizations.
• Obtain authorizations for all levels of care and perform medical necessity review.
• Monitor patient benefits and ensure compliance with SJMC contractual agreements; collaborate with multiple hospital departments.

Skills

Healthcare experience

Education

Bachelor's degree in Health/ Human Services

Job description

The Utilization Review Specialist's primary role is the liaison between the hospitals inpatient and ambulatory services and the managed care organizations. The UR specialist is responsible for a wide range of administrative responsibilities including obtaining authorization for all levels of care, medical necessity review, monitoring of patients benefits and is knowledgeable of SJMC contractual agreements. The UR specialist works closely with numerous depts. within the hospital, including the inpatient and outpatient treatment teams, Evaluation and Referral, Benefits and Patient Accounts.

One year experience in Healthcare and/or Managed Care Setting required.

Undergraduate/Bachelor Degree (required) in Human or Health Services (preferred)