What are the responsibilities and job description for the Utilization Review Specialist position at Pennsylvania Recovery Center?
Job Overview
We are seeking a dedicated and detail-oriented Utilization Review Specialist to join our healthcare team. In this role, you will be responsible for evaluating the appropriateness of patient care services and ensuring that they meet established guidelines and standards. The ideal candidate will possess a strong clinical background, excellent analytical skills, and a commitment to providing high-quality patient care.
Duties
- Conduct thorough reviews of patient medical records to assess the necessity and efficiency of care provided.
- Collaborate with healthcare providers to ensure compliance with utilization management protocols.
- Utilize clinical knowledge to determine the appropriateness of admissions, continued stays, and discharge plans.
- Maintain accurate documentation of reviews and decisions in accordance with regulatory requirements.
- Participate in interdisciplinary team meetings to discuss patient care plans and outcomes.
- Stay updated on current medical practices, guidelines, and regulations related to utilization management.
Skills
- Strong understanding of critical care principles and practices.
- Proficiency in utilizing Cerner or similar electronic health record systems for documentation and data retrieval.
- Knowledge of utilization management processes and medical management strategies.
- Experience in managed care environments with a solid grasp of anatomy knowledge relevant to acute care settings.
- Familiarity with Diagnosis Related Groups (DRG) coding and its implications for patient care.
- Ability to work effectively within primary care settings as well as operating rooms (OR).
- Excellent communication skills, both verbal and written, for effective collaboration with healthcare teams.
This role is essential in ensuring that patients receive appropriate levels of care while optimizing resource utilization within the healthcare system. If you are passionate about improving patient outcomes through effective utilization review processes, we encourage you to apply for this vital position.
Job Type: Full-time
Pay: $30.00 - $40.28 per hour
Expected hours: 40 – 50 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- No weekends
Work Location: Hybrid remote in Phoenixville, PA 19460
Salary : $30 - $40