Responsibilities:

• Conduct utilization review of medical records to determine the appropriateness and necessity of healthcare services
• Evaluate medical documentation for accuracy, completeness, and compliance with regulatory guidelines
• Collaborate with healthcare providers to gather additional information or clarify documentation as needed
• Analyze medical data and make recommendations for treatment plans or alternative options
• Ensure that all utilization review activities are conducted in accordance with established policies and procedures
• Maintain accurate and detailed records of all utilization review activities

Experience:

• Minimum of 1 years of experience as a Utilization Review Nurse or similar role
• Strong knowledge of medical terminology, medical records, and medical office procedures
• Familiarity with insurance guidelines and reimbursement processes
• Excellent analytical and critical thinking skills
• Ability to work independently and make sound decisions based on clinical judgment
• Effective communication skills to interact with healthcare providers, patients, and insurance representatives Seeking an experienced Utilization Review Specialist with one year of experience capable of handling high volumes.

Knowledgeable in ACM Criteria, Levels of Care, DSM-5 Material, and 6 Dimensions of Substance Abuse. Able to identify concurrent reviews as well as rates from providers. Understanding documenting criteria for Levels of Care and knowledge of Post Acute Withdrawal Syndrome. Organizational skills are a must.

Pay:

$18.00

• $25.

00 per hour

Work Location:

Hybrid remote in Kemah, TX 77565