Utilization Review Specialist
About The Position
The UR Specialist's primary role is to act as the liaison between the hospital's inpatient and ambulatory services and the managed care organizations. This role involves a wide range of administrative responsibilities, including obtaining authorization for all levels of care, conducting medical necessity reviews, and monitoring patient benefits. The UR Specialist must also be knowledgeable of SJMC contractual agreements and works closely with numerous departments within the hospital, such as the treatment teams/programs, evaluation and referral department, and the finance department.
Requirements
- One year experience in Healthcare and/or Managed Care Setting
- Undergraduate/Bachelor Degree in Human or Health Services
Responsibilities
- Liaison between the hospitals inpatient and ambulatory services and the managed care organizations
- Obtaining authorization for all levels of care
- Medical necessity review
- Monitoring of patients benefits
- Knowledgeable of SJMC contractual agreements
- Works closely with numerous departments within the hospital, from the treatment teams/programs, evaluation and referral dept, and the finance dept
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Number of Employees
1-10 employees
