Utilization Review Specialist
Sevita•Portage Lakes, OH
•Onsite
About The Position
The Utilization Review Specialist is responsible for proactive planning measures, accurate documentation of services delivered for audit assurances, and positive outcomes regarding effective service utilization to customers. Provides professional oversight of service delivery authorizations and assurances, effective tracking and timely recommendations in regards to service delivery utilization parameters, and quality assurance of service delivery records on an ongoing basis.
Requirements
- Bachelor’s degree required
- 1 year minimum work experience in human services required
- Basic Excel skills
- Ability to learn the Ohio state billing software
- Travel as needed
Responsibilities
- Develops plans to accurately measure documentation of services delivered to assure compliance with auditors
- Oversees service delivery authorizations and provides quality assurances of service delivery records
- Reviews all service delivery documentation
- Analyzes the delivery of services and coordination of required service documentation including corresponding billing tickets
- Tracks current and approved Individual Service Plan and corresponds with areas of support services and service delivery documentation records
- Verifies billing ticket/pre invoices submitted for processing with all required information
- Recommends service delivery utilization parameters
- Maintains knowledge of updated funding Rules and Contracts
- Notifies internal stakeholders for any updated information on service delivery, authorizations, and utilization of services
- Maintains organized and complete records and assures quality focused service delivery method strategies
- Monitors the regional office and storage filing systems
- Organizes records including availability for compliance audit file review
- Provides technical assistance to clinical staff in the service areas
- Facilitates timely and appropriate service authorization
- Monitors strategies
- Provides report analysis of actual service deliveries in comparison to authorized service approvals
- May direct and supervise clerical and administrative staff
- Provides feedback on performance evaluations
- Conducts scheduling, orientation, and training
- Resolves issues and serves as resource
- Performs other related duties and activities as required
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
