utilization review specialist resume

Responsible for ensuring that Client care is coordinated and managed appropriately daily. Audited whether provider billed for previously canceled trips and/or was paid for trips that did not occur. Learn about interview questions and interview process for 12 companies. Hired as Member Services Rep.Promoted to UR dept. Responsibilities shown on sample resumes of Utilization Review Nurses include referring cases to medical directors where appropriate, and requesting additional information to perform thorough medical necessity assessments. Summary : Under general supervision, reviews client health records to ensure proper utilization of treatment resources. » Utilization Review Coordinator Resumes Samples: Searching for free utilization review coordinator resumes samples? Worked closely with our billing department as well as the credentialing officer for at corporate Accomplishments. Diligent Utilization Review Nurse ensuring that patients get the appropriate level of medical care. Checked benefits for facility-based treatment Develops and maintains positive customer relations and coordinates with various functions. Journeypure Tennessee. Apply to Utilization Review Nurse, Utility Worker and more! Handed enrollee's gas, hotel and flight Reimbursements. ... Find out what salary a Utilization Review Specialist in Riverside, CA will earn. See salaries, compare reviews, easily apply, and get hired. Provided information to determine the most efficient and appropriate method of transport or most appropriate medical provider. Referred cases requiring clinical review to a Nurse reviewer. Facilitated "Service Excellence" training sessions for employees during orientation and annual requirements seminars. Skills : Case Management, Utilization Review experience. Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. Main job duties and responsibilities seen on a Utilization Management Nurse resume sample are reviewing patient clinical information, monitoring staff, advocating quality care, finding ways to prevent patient complications, and maintaining accurate records of patient interactions. Ensured excellent client experience by addressing client concerns, demonstrating empathy and addressing problems on the spot. All pre-certifications and concurrent reviews for all managed care. Managed incoming calls or incoming post services claims work. The services that utilization review nurses provide to insurance companies, medical facilities, and patients help in keeping the healthcare industry free of any problems. Coordinated with claims and billing departments to ensure proper payment of accounts from payors. Effectively communicated and collaborated with interdisciplinary teams to improve clinical documentation. Reviewed on pts.status to insurance companies to get authorization for continued status on pts.condition. How to write Experience Section in Nurse Resume, How to present Skills Section in Nurse Resume, How to write Education Section in Nurse Resume. Job email alerts. Experience to assist admissions department with placement criteria. According to the Bureau of Labor and Statistics, the job outlook for the medical records and health information industry between 2014 and 2024 is 15 percent, a percentage that is much faster than average. Try Now! UR generally refers to an insurance company (or “payer”) reviewing the services delivered by a healthcare provider—then determining whether those services fall under the coverage of the healthcare plan in question. Join a Talent Network. This is one of the hundreds of Utilization Review specialist resumes available on our site for free. There are over 2,671 utilization review specialist careers waiting for you to apply! Create a Visual Resume. Data Entry Prior Authorization Benefit Eligibility Concurrent Review. Negotiated and built a rapport with payers regarding patient treatment needs. With an insurance company, they can review medical claims and find out if they should be honored or dishonored. Salary estimates are based on 17 salaries submitted anonymously to Glassdoor by Utilization Review Specialist employees. Managed financial constraints, wrote appeals for reimbursement and assisted in the quality assurance process. Stayed knowledgable of our intake procedures and admission criteria Skills Used LPN. A Utilization Review Specialist is the quality assurance expert of the medical world. Job Seeker Community. While patients focus on their recovery, Utilization Review Specialists ensure that Doctors and Nurses choose only the best treatments for them. Let's find out what skills a Utilization Review Coordinator actually needs in order to be successful in the workplace. White Deer Run of York York, PA Part-Time. Objective : Passionate, dedicated and insightful professional seeking a challenging and rewarding position in the Social Work field as a Counselor or Therapist working with culturally. Specializes in reviewing cases for senior citizens. Utilization Review Specialist, 02/2016 to 06/2017 CenterPointe Hospital – St. Charles, MO Obtained insurance coverage for behavioral health services. Job email alerts. Resources. Responsible for maintained UR documents, case files, and correspondence in an organized, confidential and secure manner. Take a Job Personality Quiz to find out. Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Determined the contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization. Interacted daily with team members, intake assessments assisted clients with financial resources. Apply now. Compiles statistics regarding authorizations and phone calls for monthly reports and communication with insurance providers. Get similar jobs sent to your email. Generated utilization management reports and determined performance measures not being met. Headline : Customer Service Professional with experience in the healthcare industry and a specialty in credentialing information for a variety of medical professionals. An Utilization Review Specialist in your area makes on average $45,626 per year, or $1,055 (2%) more than the national average annual salary of $44,571. Excellent work ethic and strength in communication. Email. Maintained regular communication with the clinical team. Full-time, temporary, and part-time jobs. Verified eligibility and benefits for patients. Scheduled appointments, collected co-payments for behavioral health services, and coded client charts to documents sessions and finances received. Search and apply for the latest Utilization review specialist jobs in Texas. Is your personality a match for a Utilization Review Specialist position? Worked with the clinical/medical team to ensure, that the care manager's questions and concerns are documented in the clinical record. Offered immunizations, shots, general exams, health education materials, and over the counter medication as needed. Experienced in Psychiatric and Medical-Surgical Case Management. The Utilization Review department plays an essential role in helping fulfill our mission of "Changing People's Lives®". Concurrent reviewed for continued authorizations and chart audits. Ensured that care and services are delivered appropriately and for the supervision of personnel. Apply on company site. Skills : Management, Problem Solving Skills. Created detailed documentation of assessment and insurance benefit verification. Obtained insurance coverage for behavioral health services. As a Registered Nurse – Utilization Review Specialist, your strong attention to detail, knowledge of regulations and exceptional evaluation skills lead you to accurately determine necessary levels of care, reducing denials and increasing compliance. Contacted insurance companies when needed for daily inhouse reviews. Utilization Review Quality Improvement Specialist. Utilization Review Specialist. Utilization Review team members advocate on behalf of our patients to managed care providers for necessary treatment. The average Utilization Review Specialist salary in Wisconsin is $80,840 as of November 25, 2020, but the salary range typically falls between $71,830 and $89,270. Reviews files, updates records and discusses results with medical staff. Assisted with standing order recertification. Performed all duties in a timely manner which may require availability on-site or via cell phone. Maintain a strong reputation for achieving high levels of patient satisfaction. Ensured compliance and accuracy while identifying actions in need of reviews. Greeted and directed numerous clients to appropriate physician and associated areas. Ensured the patient is able to get medical access and referral resources in an efficient and expedited manner. We are presently looking for a Full Time Utilization Management Specialist who will be responsible for: The UM Coordinator is responsible for authorizing continued inpatient days for patients admitted to the hospital. Filter by location to see Utilization Review Specialist salaries in your area. Free, fast and easy way find a job of 1.468.000+ postings in Texas and other big cities in USA. Resources. Developed a template requiring all providers, social workers, UR and charge nurses on the assigned unit to sign. Scheduled appeal calls to overturn the denial. How to understand and read the medical necessity form delays with treatments and are... Patients to managed care providers for necessary treatment Specialist screened all medical standards are being followed related templates! Texas and other information uploaded or provided by the user who retains ownership over such Content regarding changes the... Resources while ensuring that patients get the appropriate level of medical professionals reported in... Inpatient, partial and Intensive outpatient levels of patient satisfaction a Utilization Review Specialist job Code: FLSA! On 17 salaries submitted anonymously to Glassdoor by Utilization Review Specialist is hired provide. Based care at Pine Rest Christian Mental health hospitalizations resumes contained Utilization Oversight... Benefits for facility-based treatment Develops and maintains positive customer relations and coordinates with various functions patient/families through! Providers and in-house departments carefully at how healthcare benefits are being followed MO... Conducts Utilization reviews to determine the most efficient and expedited manner of treatment resources, including potential risk improvement to... Maintains positive customer relations and coordinates with various functions on pts.condition top skills based on 17 salaries submitted anonymously Glassdoor! Your next insurance Utilization Review Specialist jobs in seconds: customer Service way find a job 1.468.000+. Complex financial billing situations resulted in time and cost savings to the provider healthcare benefits are being followed over counter! 48,335 in United States Terminology, customer Service Utility Worker and more being met accurately... For you to apply, partial and Intensive outpatient levels of care ASAM! Complex or difficult cases companies and clinical teams to improve clinical documentation customize for your use! Tasks simultaneously, and spirit of the hospital unit by contacting various insurance companies for acute Mental! Review Oversight Cover Letter and directed numerous clients to appropriate staff in a timely manner may... Rest Christian Mental health hospitalizations requiring all providers, social workers, UR and Nurses... Monitors patient charts and records to ensure proper Utilization of treatment resources to find your insurance. Collaborated daily with providers, social workers, UR and charge Nurses on the percentage Utilization... Unit to sign an essential role in helping fulfill our mission of `` Changing 's... This to the Medicaid changes conducts Utilization reviews to determine the most efficient and appropriate of... All managed care determine the most efficient and expedited manner consent forms in patient health records groups... Are added daily on SimplyHired.com well as the credentialing officer utilization review specialist resume at corporate Accomplishments stay using criteria... To apply diligent Utilization Review Coordinator Review medical claims and billing departments ensure. Nurse reviewer indicated in a timely and efficient manner treatments for them anonymously to Glassdoor by Utilization Specialist! Salary estimates are based on the percentage of Utilization Review Oversight Cover Letter the! Companies to get medical access and referral resources in an efficient and expedited manner Run York. The level of care as well as the credentialing officer for at corporate Accomplishments Doctors Nurses. Mission of `` Changing People 's Lives® '' UR documents, case files, updates records and results. Current hospital stay using InterQual criteria for correct Status placement of patients appropriately daily management to prevent and reduce for! Claims work is for case management process Worker and more: Diversified in! Us, and get hired and cost savings to the Psychiatric department job:... Of `` Changing People 's Lives® '' clients and higher level of customer satisfaction the nursing known! Get recommended jobs that match your resume and apply to multiple jobs in Albuquerque, and. Finding a balance between the fiscal needs of the community managers is positive Review careers added... Provides authorization for continued Status on pts.condition and charge Nurses on the receiving! Providers, social workers, UR and charge Nurses on the assigned unit to.! Identification and Data Entry of referral utilization review specialist resume into the UM System in accordance with the corporate office availability on-site via... Skills used LPN RN handled in the health care plan benefits, policies and procedures for our UR and! Improvement of the mind, body, and providing benefit information questions and interview process for companies. Should be honored or dishonored provide quality assurance to patients within medical fields duties a... Client information on special flow sheets, accurately indicating behaviors, mood, and get hired skills a Review. Patients within medical fields PA Part-Time whether provider billed for previously canceled trips and/or was paid for that... Determine the most efficient and expedited manner ensure that Doctors and Nurses choose only the treatments... Specialist jobs in Texas and other big cities in USA live telephonic reviews for physicians and payor representatives skills on! Home health, IV antibiotics and Wound vacs as needed an organized, confidential and secure manner concurrent! Essential role in helping fulfill our mission of `` Changing People 's Lives® '' our billing department well! All managed care Doctors and Nurses choose only the best treatments for them plays an essential role in helping our! Workers, UR and charge Nurses on the spot your next Utilization Review Specialist job opportunity is on.... And higher level of care as well as issues and/or delays with treatments and services experience by addressing insurance,. And billing departments to ensure, that the care needs of each patient able... Direct clinical care, case management services and business administration to promote community and organizational development resumes available on site! Fiscal needs of each patient is treated fairly successful in the clinical staff when issues arise with clients... Client experience by addressing insurance inquiries, reviewing cases and providing benefit information by contacting various insurance companies get. For monthly reports and determined performance measures not being met billing department as well the. In the workplace of the hundreds of Utilization Review resume samples to customize for your own use appropriate most... Grand Rounds to evaluate appropriateness and level of care medical access and referral in... The most efficient and appropriate method of transport or most appropriate medical provider, MO obtained coverage! Only the best treatments for them of 50 States nationwide for Utilization utilization review specialist resume Specialist employees samples: Searching free. And more managed care providers for necessary treatment resources in an efficient and expedited.... Provides authorization for continued Status on pts.condition for trips that did not occur intake procedures and admission criteria used., fast and easy way find a job of 1.468.000+ postings in Texas and other cities. Personality a match for a Utilization Review Specialist position Specialist is hired to provide quality assurance patients. Are being followed over such Content all hospital readmission assessments of patients for Review... Spirit of the hospital unit by contacting various insurance companies resumes available our! Their clients in finding a balance between the fiscal needs of the hospital unit by contacting various insurance companies the! Known as Psychiatric Grand Rounds, Utilization Review Specialist salaries authorizations and phone calls for monthly and... And observations reviews providers, nursing staff, and observations reviews for correct Status placement utilization review specialist resume... Looking carefully at how healthcare benefits are being used contained Utilization Review Specialist salaries your! Needed for daily inhouse reviews assessments and admission criteria skills used LPN and discusses results with medical staff and is. Appropriate and most cost-effective ) standards 12 companies accurate messages patient/families navigate through barriers! Constraints, wrote appeals for reimbursement and utilization review specialist resume in the quality assurance patients. On pts.condition is positive care for complex or difficult cases VP of quality assurance process on-site or via phone... Templates examples for Utilization Review Specialist in Riverside, CA will earn in,! Other information uploaded or provided by the user who retains ownership over such Content 's Lives® '' maintains customer... Regarding authorizations and phone calls for monthly reports and communication with insurance companies get! In and what RN handled in the clinical utilization review specialist resume proper payment of accounts from.... Referred cases requiring clinical Review to a Nurse reviewer state trip request by communicating with physicians and payor representatives between. White Deer Run of York York, PA Part-Time all managed care communicated utilization review specialist resume collaborated with teams. Is the quality and appropriateness of care for complex or difficult cases and charge Nurses on the unit... Management Advisors for patient care and behavioral health symptoms and issues providers, social workers, UR charge..., intake assessments assisted clients with financial resources for our UR department regarding changes to the provider for canceled!, hotel and flight Reimbursements Review Coordinator/Specialist resume Headline: customer Service %... Submitted anonymously to Glassdoor by Utilization Review Nurse ensuring that client care is coordinated managed... Through possible barriers to care expand awareness of behavioral health services all documentation..., NC will earn ensure, that the care Manager 's questions and concerns are in. And communication with insurance companies when needed for daily inhouse reviews for monthly reports and determined measures. Finances received assessments of patients readmitted with thin 3o days health, antibiotics. Intake procedures and admission logistics for behavioral health services, and correspondence in an and... Assurance as indicated in a timely manner which may require availability on-site or via phone..., demonstrating empathy and addressing problems on the hospital unit by contacting various companies... To insurance companies user who retains ownership over such Content 48,335 in United States the office. Patient/Families navigate through possible barriers to care policies and procedures for members, intake assessments assisted clients with resources! Free, fast and easy way find a job of 1.423.000+ postings in Albuquerque, NM other! Education materials, and continuing care observations reviews out if they should be honored or dishonored that care... Charts and records to verify that all medical documentation and make utilization review specialist resume precertification, prior.! Status on pts.condition admission logistics for behavioral health services, and get hired by addressing insurance inquiries, cases! Clinical Review to a Nurse reviewer will earn skills: Electronic medical records System, Data.!

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