Utilization Review/Insurance Specialist
: Job Details :

Duties- Review medical records to determine the medical necessity and appropriateness of requested services- Conduct utilization reviews to ensure compliance with insurance guidelines and policies- Collaborate with healthcare providers to gather additional information or clarify documentation- Evaluate treatment plans and make recommendations for alternative options if necessary- Communicate with insurance companies, patients, and healthcare providers regarding utilization review decisions- Maintain accurate and detailed documentation of all utilization review activitiesSkills- Strong knowledge of medical terminology and procedures- Familiarity with medical office operations and electronic health records systems- Excellent analytical and critical thinking skills- Strong attention to detail and ability to work independently- Effective communication skills, both written and verbal- Ability to prioritize tasks and meet deadlines in a fast-paced environmentThe Utilization Review Nurse plays a crucial role in ensuring the appropriate utilization of healthcare services. As a Utilization Review Specialist, you will be responsible for reviewing medical records, conducting utilization reviews, and collaborating with healthcare providers to ensure that patients receive the most appropriate care. Your expertise in medical terminology, medical office operations, and electronic health records will be essential in evaluating treatment plans and making recommendations for alternative options when necessary. Strong analytical skills, attention to detail, and effective communication will also be key in this role.Job Type: Full-timeBenefits:* 401(k) matching* Dental insurance* Employee assistance program* Flexible spending account* Health insurance* Life insurance* Paid time off* Tuition reimbursement* Vision insuranceSchedule:* Monday to FridayWork Location: In person