Utilization Review Technician conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Technician reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Technician consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). The Utilization Review Technician gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Utilization Review Technician typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Remote Work: This position is eligible to work remotely as approved by management
Position qualifications:
Graduate from an accredited school of Nursing and licensed as a Registered Nurse in the State of Colorado. Two (2) years previous experience in a psychiatric hospital or other psychiatric setting preferred. Experience in utilization review with insurance companies/payers preferred. Background in an inpatient, emergency room, or family practice setting desirable.
Job purpose:
Perform concurrent reviews to justify continued hospitalization, ensuring all services will be reimbursed and the quality of services provided align with organizational standards and applicable regulations for inpatient psychiatric hospitals.
Knowledge, Skill & Ability (include materials and equipment directly used):
Working Conditions/Physical Demands:
Employee must occasionally lift and/or move up to 25 pounds. Employee is frequently required to walk, sit, stand, or kneel and occasionally required to climb or balance, and stoop. Must have the ability to sit for longer periods of time at a computer. Employee must be able to travel between Mind Springs sites. May be exposed to stressful situations that involve enraged, distraught, and/or intoxicated individuals with possible mental health conditions. Possible exposure to communicable disease. The noise level in the work environment is usually moderate. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
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