A Clinical Auditor or Utilization Reviewer reviews the efficiency of healthcare delivery. Individuals tend to have had experience as a registered nurse or other healthcare delivery roles before transferring into this quality review role.
Thrive Wellness of Reno Job Description Utilization Review/Higher Level of Care Specialist Location:
Reno, NV Pay Range:
$24-$28/hour pending experience Our Utilization team is seeking a dedicated and compassionate Utilization Review Specialist to join our team. This position will report directly to the Director of Utilization Review. The ideal candidate will play a crucial role in ensuring the quality and appropriateness of healthcare services provided to patients. This position is classified as salaried, exempt, and full-time.
Qualifications:
Bachelor's Degree preferred. Previous experience in utilization review or related healthcare field (preferred). Strong understanding of medical terminology and procedures. Proficiency in medical documentation practices. Excellent communication and interpersonal skills. Ability to work collaboratively in a multidisciplinary team environment. Detail-oriented with strong analytical skills. Proficient in spelling, grammar, multi-tasking. Strong commuter skills - EMR, Microsoft/Google programs, insurance web portals. Self-starter who learns quickly. Demonstrates competency and sensitivity in the areas of multicultural, racial, religious/spiritual, gender, gender identity, gender expression and sexual orientation issues.
Requirements:
Must pass a federal background check at hire. Must adhere to the drug-free workplace act. Demonstrate maturity of judgment, attitude, and life skills. Must demonstrate an ability to adapt to change and remain flexible. Must be a strong team player that works well in a busy environment. Must have strong communication skills and be upbeat, positive, and professional when interacting with clients, providers and fellow co-workers. Must have excellent interpersonal, verbal, and written communication skills, as well as the ability to effectively prioritize and manage your time unsupervised & independently.
Duties:
Conduct utilization review to assess medical necessity of various treatment programs. Review medical documentation for accuracy and completeness. Collaborate with doctors to optimize patient care and outcomes. Implement health information management practices to maintain patient records. Assist in discharge planning to ensure smooth transitions for patients. Adhere to HIPAA regulations for patient confidentiality. Participate in medical management processes to enhance patient care. Engage in case management activities for comprehensive patient support. Other duties as assigned.
Core Values:
The ability to demonstrate, understand and apply our company core values in every aspect of your role is a MUST. The selected candidate will be expected to demonstrate the core values in their everyday work. Courageously Optimistic Wholeheartedly Steadfast Rooted in Community Keep Growing Thrive Wellness does not discriminate any person based on race, creed, color, religion, national origin, sex, age, physical or mental disability, gender, gender identity or gender expression, and genetic information unrelated to an individual's ability to perform the essential functions of a particular job, status as a military veteran or qualified disabled veteran, any other characteristic or any other projected class status in accordance with applicable federal, state and local laws.
Job Type:
Full-time Pay:
$24.00 - $28.00 per hour
Benefits:
Dental insurance Health insurance Paid time off Vision insurance
