Utilization Review Specialist
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.
PI244078432
Compensation Information :
$0.0 / - $0.0 /
Starting At : 0.0
Up To : 0.0
Utilization Review Specialist
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. Int...
Outpatient Registered Nurse - RN
The registered professional nurse (CAP RN 1) position is an entry level designation into the Clinical Advancement Program for Registered Nurses. Entry level for RNs with less than 2 years of nephrology nursing experience within the last two years or for RNs with a BSN and less than 1 year of nephrol...
Travel Registered Nurse - ICU/Critical Care - $2,210 per week in Salem, MA
CoreMedical Group has hundreds of exciting and rewarding travel assignments throughout the country for Travel Allied Professionals and Travel Nurses. As a travel allied professional or a traveling nurse with CoreMedical Group, you are eligible for some of the best benefits in the industry, including...
Travel Registered Nurse - Dialysis - $1,495 per week in Burlington, MA
We are currently seeking qualified candidates for RN.Shift Custom Shift Day, 00:00:00-08:00:00, 8.Day 1 Medical, Health, Dental, Vision....
Travel Registered Nurse - ICU/Critical Care - $2,318 per week in Beverly, MA
Atlas Medstaff is currently seeking candidates in the RN (ICU/CCU/Critical Care) profession for a 13 week contract in the Beverly, Massachusetts area.Atlas Medstaff is a premier staffing firm dedicated to matching outstanding talent with exceptional opportunities.Our commitment to excellence and our...
Travel Registered Nurse - ER/Trauma - $2,505 per week in Massachusetts
Travel Nursing: Emergency Department Worcester.Location: Worcester.Start Date: 10/2/2024.Shift Details: 12H Nights (7:00 PM-7:30 AM).Length: 27 WEEKS 27 weeks.Apply for specific facility details....
Travel Registered Nurse - Labor/Delivery - $2,325 to $2,578 per week in Salem, MA
Ready to start your next travel adventure? LRS Healthcare offers a full benefits package, 24/7 support, and a responsive, traveler-first culture.What are you waiting for? Apply today!.Valid license and/or certification in state of practice, if applicable .Demonstrated ability to maintain high l...
Travel Nurse - Registered Nurse - PACU - Post Anesthesia Care Unit - $2520 / Week
Smarter Healthcare Partners is seeking an experienced Post Anesthesia Care Unit Registered Nurse for an exciting Travel Nursing job in Lawrence, MA. We provide nurses and allied health professionals with the highest pay and best benefits possible. ...
Travel Nurse - Registered Nurse - LD - Labor and Delivery - $2600.4 / Week
Host Healthcare is seeking an experienced Labor and Delivery Registered Nurse for an exciting Travel Nursing job in Salem, MA. As a nurse, allied, or therapy professional, you will be matched to one of our responsive recruiters who will have your back throughout your journey. ...
RN Case Manager
Our Home Health RNs tell us they love the ability to work autonomously, to build strong rapport with their patients and families, and the flexibility in managing their schedules. Assesses patient/family learning needs, style and limitations and adjusts for delivery of information. Effectively manage...