Utilization Review Specialist Position Available In Palm Beach, Florida

Utilization Review Specialist Recreate Behavioral Health Network – 4.5 Boca Raton, FL Job Details Part-time $32,000 – $35,000 a year 10 hours ago Qualifications Utilization review Mid-level Bachelor’s degree 2 years Documentation review Communication skills Full Job Description RBHN is looking for a Utilization Review Specialist to join our team of healthcare professionals. The Utilization Review Specialist is responsible for reviewing and evaluating clinical documentation, treatment plans, and medical records to optimize patient care and streamline healthcare delivery processes. A vital component of their duties is to work closely with other departments in the company to deliver effective services to the program.

Responsibilities:

Evaluate and analyze medical records, treatment plans, and clinical documentation to ensure accuracy and compliance with established standards. Collaborate with healthcare providers to gather additional information or clarification on documentation when necessary. Assess the appropriateness and necessity of healthcare services, ensuring they align with established guidelines and policies. Identify and communicate potential issues related to overutilization or underutilization of services. Participate in quality-improvement initiatives to enhance the overall efficiency and effectiveness of healthcare delivery. Provide feedback and suggestions for process improvements based on review findings.

Required Skills:

Understanding of compliance requirements and the ability to ensure adherence during the utilization review process. Familiarity with industry standards, guidelines, and best practices related to utilization review. Ability to analyze complex clinical documentation, treatment plans, and medical records. Stay informed on relevant healthcare regulations, guidelines, and accreditation standards. Ensure compliance with all applicable laws and regulations in the utilization review process. Strong critical thinking skills to assess the appropriateness and necessity of healthcare services. Excellent communication and interpersonal skills. Ability to work collaboratively in a team-oriented environment. Education/Experience and Other Requirements Bachelor’s degree in a healthcare-related field (Preferred) Proven experience in utilization review or a related field with a strong understanding of healthcare service delivery and documentation processes. Experience with Ambetter is highly desirable. We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.