What are the responsibilities and job description for the Utilization Review Specialist position at Umpqua Health Management LLC - HCM?
The Role :
As a Utilization Review Specialist , you will be responsible for ensuring that healthcare services are medically necessary, efficiently provided, and appropriately utilized . This role involves reviewing patient medical records, assessing and evaluating requests for medical services, treatments, or procedures to determine their appropriateness, and ensuring compliance with regulatory and payer requirements. You will also play a key role in the intake, processing, and finalization of all prior authorizations received by the Medical Management team, coordinating with healthcare providers to facilitate accurate and timely approval of services. Your work will directly support the goal of delivering high-quality, cost-effective care.
Your Impact :
- Performs data entry of authorization information (per policy / procedure) into web-based system as received through telephone calls, voice mail messages and emails.
- Gathers and organizes clinical information for review.
- Communicates authorization request status to the providers as per policy and procedure.
- Writes coverage determination letters.
- Works with computer / electronic medical records daily.
- Perform other duties as assigned by management to help drive our Vision, fulfill our Mission, and abide by our Organizations Values.
Your Credentials :
Salary : $19 - $23
