Utilization Review Specialist

Duties/Responsibilities

• Establish processes to verify the medical necessity and appropriateness of outpatient admissions
• Conduct concurrent reviews to ensure extended stays are justified and properly documented
• Track patient lengths of stay and continued-stay days
• Refer non-compliant cases to the Physician Advisor for further evaluation
• Collaborate with the Utilization Review Committee to identify and resolve review-related issues
• Flag quality-of-care concerns and escalate them to the Quality Assurance Committee
• Cook with Social Services to support timely discharge planning
• Prepare and present monthly utilization reports and key metrics

Requirements

• Strong verbal and written communication abilities
• Exceptional organizational skills and keen attention to detail
• Proven time management skills with the ability to meet deadlines consistently
• Proficiency in Microsoft Office Suite and related software applications

Qualifications

• Associate's or Bachelor’s degree in a healthcare related field preferred
• 1–2 years of experience in utilization review
• Active CPR certification