Find & Apply For Clinical Auditor / Utilization Reviewer Jobs in Hemet, California

POSITION SUMMARY

Reviews all authorization request due to timeliness, medical necessity and appropriate guidelines. Communicates with medical director daily to discuss possible modifications and denials. Key responsibilities

Include:

Assist in the prospective review process by screening referrals for adequate information, approving specific referrals according to policy and procedure, and serving as a resource to the staff and for utilization management related issues. Provide concurrent monitoring, tracking and authorization of ongoing outpatient services, i.e. home health, DME, IV therapy and supplies for appropriateness and medical necessity. Documentation of retrospective review of unauthorized claims/services for payment based upon reasonable criteria developed and approved. Service as a liaison between Utilization Management and Quality Management Departments to report all quality of care issues.

Job Type:

Full-time Pay:

From $31.00 per hour

Benefits:

401(k) Dental insurance Health insurance Life insurance Paid time off Vision insurance

Work Location:

In person