Utilization Review Specialist

Responsibilities: The specialist evaluates patient records and treatment plans to ensure healthcare services are medically necessary and compliant with regulatory standards. They collaborate with providers and insurance companies to facilitate authorizations and optimize patient outcomes.

Requirements: A bachelor's degree in healthcare or a related field and at least 2 years of experience in utilization review or clinical roles are required. Knowledge of medical terminology and insurance authorization processes is essential.

Key skills: Utilization Review, Case Management, Medical Terminology, Insurance Authorization, Healthcare Reimbursement, Analytical Skills, Communication Skills, Organizational Skills, Electronic Health Records (EHR), Utilization Management Software, Clinical Documentation, Regulatory Compliance

Keywords: Utilization Review, Case Management, Medical Necessity, Clinical Data, Insurance Authorization, Healthcare Reimbursement, EHR, Certified Professional in Utilization Review, Certified Case Manager, Medicare, Medicaid, Payer Guidelines, Managed Care, Clinical Guidelines, Regulatory Compliance