Utilization Review Specialist Job at Reno Behavioral Healthcare Hospital, Reno, NV

RU90dWJHQVpDSHN0VzdPZ3htTlcvdVJ1eXc9PQ==
  • Reno Behavioral Healthcare Hospital
  • Reno, NV

Job Description

The UR Specialist reviews and monitors patients’ utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties include providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency of medical services and procedures.

  • Performs concurrent and retrospective reviews on all patients. Monitors level and quality of care.
  • Responsible for the proactive management of patients with the objective of improving quality outcomes and decreasing costs.
  • Evaluates and provides feedback to treating physicians regarding a patient’s discharge plans and available covered services, including identifying alternative levels of care that may be covered.
  • Monitors all utilization reports to assure compliance with reporting and turnaround times.
  • Addresses care issues with the Director of Clinical Services and Chief Medical Officer/Medical Director as appropriate.
  • Coordinates an interdisciplinary approach to support continuity of care.
  • Provides utilization management, transfer coordnation, discharge planning, and issuance of all appropriate authorization for covered services as needed.
  • Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
  • Clarifies health plan medical benefits, policies and procedures for members, physicians, staff, contract providers, and outside agencies.

Requirements

  • Bachelor's degree in Social Work or related field required.
  • Clinical Licensure in the State of Nevada preferred.
  • Knowledge of medical terminology, medical records, and appropriate medical coding system.
  • Working knowledge with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint).
  • Maintains confidentiality of patients at all times.

Benefits

We proudly offer the following benefits available first of the month following just one month of employment:

  • Competitive rates
  • Flexible schedules
  • Tuition reimbursement
  • Comprehensive package of benefits to include:
    • Medical
    • Dental
    • Vision
  • Life, Pet, Identity Theft Insurance
  • 401k
  • Generous paid time off
  • Short Term and Long Term Disability

Job Tags

Full time, Contract work, Temporary work, Flexible hours,

Similar Jobs

Simplot

Truck Driver (Portland, OR) Job at Simplot

 ...The J.R. Simplot Company is a diverse, privately held global food and agriculture company headquartered in Boise, Idaho. We are a true...  ..., prepares product for delivery, securely loads product on the truck for delivery to customer locations following company required safety... 

GrowthWise Search Partners

Sales Representative / Roofing Inspector Job at GrowthWise Search Partners

 ...with customers, and working in the trades Are confident in your sales abilities and excited for uncapped commission earnings potential...  ...career and earnings. Your Opportunity: Sales Representative/Roofing Inspector Sales Representative/Roofing Inspector - Your... 

TalentSphere

Commercial Roofing Project Manager Job at TalentSphere

 ...Commercial Roofing Project Manager Ready for a Change of Scenery? This Might Be Your Next Big Move. Location: Austin, TX (Relocation Assistance Available) Compensation: $90,000$110,000 + Bonuses + Full Benefits Take the Lead on High-Stakes ProjectsAnd Start... 

The Farrington Inn

Front Desk (Evening Shift) Job at The Farrington Inn

 ...hotel. Schedule: Monday Tuesday Wednesday Thursday Friday 4pm -12am The job will include customer service, housekeeping, and random odd jobs that come up during the day. Job Details: ~ Be able to carry 50 pounds up a flight of stairs. ~$20 per hour.~ Full-... 

Pi-Square Technologies LLC

Network Engineer Job at Pi-Square Technologies LLC

JD: Network engineers experienced with InfiniBand and Ethernet experience for configuring and managing the high-performance computing (HPC) / artificial intelligence (AI) datacenter environment. Must have: Hands-on experience with InfiniBand and Ethernet, including...