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The Utilization Review Specialist -St. Veronica Senior Behavioral Health
Bel Aire, KSPosted 4 days ago
onsite
Job Description
Job Id:
2648
# of Openings:
1
E-Verify Statement: This employer participates in the Electronic Employment Verification Program.
Position Summary
We are seeking a highly organized and detail-oriented Utilization Review Specialist to join our team at St Veronica Hospital. The Utilization Review Specialist plays a crucial role in ensuring efficient utilization of resources and optimal patient care delivery. The primary responsibility of this role is to review medical records, treatment plans, and insurance information to determine the appropriateness and necessity of healthcare services provided to patients. The ideal candidate will possess strong analytical skills, excellent communication abilities, and a deep understanding of medical terminology and healthcare regulations.
PRINCIPAL DUTIES AND RESPONSIBILITIES
- Review medical records and treatment plans to assess the appropriateness and necessity of healthcare services.
- Verify insurance coverage and benefits to ensure accurate billing and reimbursement.
- Communicate with healthcare providers, insurance companies, and patients to gather necessary information and resolve discrepancies.
- Collaborate with physicians and other healthcare professionals to develop and implement effective treatment plans.
- Monitor the utilization of resources, such as hospital beds, medical equipment, and staff, to ensure optimal efficiency and cost-effectiveness.
- Conduct concurrent and retrospective reviews to evaluate the quality and outcomes of patient care.
- Identify opportunities for improvement in care delivery processes and make recommendations to enhance efficiency and quality.
- Stay updated on changes in healthcare regulations and insurance policies to ensure compliance with relevant guidelines and requirements.
- Document all review activities, decisions, and communications accurately and comprehensively.
- Participate in interdisciplinary meetings and committees to provide input on utilization management strategies and initiatives.
Management Responsibilities
- N/A
Education and/or Experience
- Bachelor's degree in nursing, healthcare administration, or a related field (preferred).
- Minimum of 2 years of experience in utilization review or a related field.
Certificates, Licenses, Registrations
- Registered Nurse (RN) license or other relevant healthcare licensure/certification (preferred).
- Must have an unrestricted class “C” driver's license if company vehicles are in “C” class.
- CPR Certification preferred for Assisted Living; required for LTC upon hire, or within thirty (30) days of employment.
Equal Employment Opportunity Employer:
Catholic Care Center is an Equal Employment Opportunity (EEO) and Affirmative Action employer. Associates and Applicants receive fair and impartial consideration without regard to race, color, religion, national origin, citizenship, gender identity, sexual orientation, age, physical or mental disability, veteran status, genetic data, or other legally protected status.
Pay Non-Discrimination Notice: https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf
For further information regarding your EEO rights, click on the following link to the “EEO is the Law” poster: http://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf
EEO is the Law Poster Supplement: Please note that Catholic Care Center will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Catholic Care Center will not solicit money or banking information from applicants.
Catholic Care Center is an Equal Employment Opportunity (EEO) and Affirmative Action employer. Associates and Applicants receive fair and impartial consideration without regard to race, color, religion, national origin, citizenship, gender identity, sexual orientation, age, physical or mental disability, veteran status, genetic data, or other legally protected status.
Pay Non-Discrimination Notice: https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf
For further information regarding your EEO rights, click on the following link to the “EEO is the Law” poster: http://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf
EEO is the Law Poster Supplement: Please note that Catholic Care Center will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Catholic Care Center will not solicit money or banking information from applicants.
E-Verify Statement: This employer participates in the Electronic Employment Verification Program.
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