Utilization Review Specialist: Care & Compliance Leader

Addiction and Mental Health Services; Lucedale (MS); Sur place; USD 70 000 - 90 000; Plein temps

Avantages offerts par ce poste

Medical coverage

Expanded coverage

Mental health support

Voluntary coverages

Student loan repayment

Retirement benefits

Generous PTO

Voluntary benefits for part-time

Résumé du poste

Bradford Health Services is seeking an Utilization Review Specialist to evaluate patient records and treatment plans, ensuring medical necessity and regulatory compliance. The role collaborates with providers, insurers, and case managers to secure timely approvals and optimize patient outcomes.

Applicants should have a healthcare-related bachelor’s degree, 2+ years in utilization review or related roles, and strong knowledge of medical terminology and payer policies.

Qualifications

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

Responsabilités

• Review medical records, treatment plans, and clinical documentation to assess necessity and appropriateness of services.
• Coordinate with healthcare providers, insurance reps, and case managers to obtain information.
• Make decisions on authorization, continuation, modification, or denial of services based on clinical guidelines and regulations.
• Maintain detailed records of utilization review activities and communications.
• Stay current with regulations, payer policies, and best practices to ensure compliant reviews.

Connaissances

Bachelor’s degree in healthcare

2+ years of utilization review/case mg

medical terminology knowledge

insurance authorization processes

analytical/communication/organiz.

Formation

Bachelor’s degree in healthcare

Outils

EHR systems

utilization management software

Description du poste

Bradford Health Services is seeking an Utilization Review Specialist to evaluate patient records and treatment plans, ensuring medical necessity and regulatory compliance. The role collaborates with providers, insurers, and case managers to secure timely approvals and optimize patient outcomes.

Applicants should have a healthcare-related bachelor’s degree, 2+ years in utilization review or related roles, and strong knowledge of medical terminology and payer policies.