Utilization Reviewer (FT)

Summary

The Utilization Reviewer contributes to assessment and planning by performing a thorough review of the total resources available to patient pre and post-discharge from rehabilitation care. The Utilization Reviewer collaborates with the payer and rehabilitation team to ensure a successful transition to the discharge setting and or goal achievement, and durability of outcome.

Responsibilities

• Assesses all of patient's payer sources for rehabilitation course, determines resources available for patient, and ensures maximal use of available health coverage resources for each patient.
• Completes pre-certification and prior authorization timely for admission and or services.
• Documents all insurance information appropriately on forms and in computer system as applicable.
• Functions as liaison with payer representatives to manage the rehabilitation process in keeping with the patient's financial resources, including verification of benefits for this and future settings.
• Completes retro authorizations as applicable and ensures follow through relative to authorizations for all services through the complete revenue cycle.
• Other duties as assigned.

Education and Experience

• Greater than 2 years of UR experience with a strong clinical background and competence with a rehabilitation population.
• Bachelor's degree in related field with 3-5 years' experience.
• LPN or RN experience preferred.

Schedule

• Monday - Friday (8:30am-5:00pm)
• This position is on-site at RHI