Utilization Review Specialist
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About The Position
As a Utilization Review Specialist at Duffy's Napa Valley Rehab, you will play a crucial role in ensuring that our patients receive the appropriate level of care while also adhering to the requirements set forth by managed care organizations. This position requires you to act as a liaison between the facility's professional clinical staff and managed care organizations, facilitating communication and ensuring compliance with insurance plans. You will conduct thorough reviews of patient cases in accordance with certification requirements, which will involve monitoring patient length of stay and coordinating with clinical and medical staff regarding any issues that may affect this duration. In addition to your primary responsibilities, you will gather and develop both statistical and narrative information to report on utilization metrics, including non-certified days and the quality of services provided. This data will be essential for facility leadership and the corporate office to make informed decisions regarding patient care and resource allocation. You will also conduct quality reviews to assess medical necessity and the appropriateness of services rendered, ensuring that our standards of care are met consistently. Your role will also involve performing other functions and tasks as assigned, contributing to the overall efficiency and effectiveness of the facility's operations. This position offers a unique opportunity to engage in professional growth within a supportive team environment that values defined career paths and collaboration across a national family of facilities.
