Utilization Review Specialist
About the Role
Methodist Surgery Center, part of the Surgery Partners network, is seeking an experienced Utilization Review Specialist to join its team in Addison, Texas. This position is ideal for someone with many years of experience in Utilization Review who can quickly step into the role and work independently with minimal training. This is a hybrid opportunity offering the flexibility of three remote workdays per week while maintaining an onsite presence two days per week in Addison, TX.
Responsibilities
- Perform utilization review activities for surgical patients and procedures.
- Review clinical documentation for medical necessity, level of care appropriateness, and payer requirements.
- Collaborate with physicians, case management teams, and payers to support authorization and reimbursement processes.
- Ensure compliance with Medicare, commercial payer, and regulatory guidelines.
- Identify opportunities to improve utilization management processes and patient outcomes.
- Maintain accurate and timely documentation within appropriate systems.
- Support a positive patient experience through effective coordination and communication.
Requirements
- Utilization review experience (required).
Qualifications
This role is suited for candidates with extensive experience in Utilization Review who can work independently with minimal training.
Pay
The pay range for this position is $70,000.00 - $100,000.00 per year. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.
Schedule
This is a hybrid position based in Addison, TX, requiring two onsite days per week and three remote workdays per week.
This is a permanent position.