The Utilization Review Specialist, under supervision and in collaboration with the Utilization Review Coordinator, Utilization Review Nurses, Physician advisor and healthcare team supports all administrative tasks / responsibilities for utilization management and revenue integrity cycle processes.
Interacts directly and indirectly with internal and external providers to review and monitor members' utilization of health care services with the goal of maintaining high-quality cost-effective care.
The URS works collaboratively with utilization management staff to obtain information from clinical reviews and medical records to provide the appropriate communication for authorization of medical services and procedures.
The URS is an integral member of the health care team as well as the integrated care team and supports the case management / utilization review team on system-wide quality improvement / performance improvement initiatives.
Perform other duties as needed and assigned by your supervisor.
REQUIRED EDUCATION AND EXPERIENCE :
- Bachelor’s Degree
- 1-2 year case management and utilization review experience in an acute care setting
- Knowledge and understanding of medical terminology
- Strong organizational skills
- Flexibility and accountability
- Demonstrated verbal, written skills
- Interpersonal skills required
- Critical thinking and knowledge of regulatory standards and reimbursement requirements
- Computer skills required
Lawrence General Hospital is a private, non-profit community hospital providing the Merrimack Valley & southern New Hampshire regions with patient-centered, compassionate, and quality health care for the whole family.
For over 140 years, the dedicated doctors, nurses, and staff of Lawrence General have been committed to improving the health of the people and communities we serve.
We are an Equal Opportunity Employer committed to hiring a diverse workforce.
Utilization Review Specialist
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