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)
Under limited direction and in accordance with established policies, procedures, guidelines and criteria, regularly exercises clinical judgment in the review and assessment of patients' records. Reviews care and treatment received. Communicates with third party payers in order to obtain authorization for care. Acts as a resource to related parties by providing training and educational sessions.
EDUCATION AND EXPERIENCE:
Associate's Degree in Nursing (ADN), OR Licensed Practical Nurse (LPN), OR Bachelor's Degree in Social Work. Registration Health Information Administrator (RHIA), preferred. Minimum of five years of progressively more responsibility. ADDENDUM Henry Ford Macomb-Behavioral Health departments: Experience: 2-5 years behavioral health specific. Education: In addition to above, also acceptable Associate or Bachelor's in a related field (i.e., Psychology) preferred with required behavioral health experience.
WORKING CONDITIONS: Works in a normal patient care environment with little exposure to noise, dust, temperature and the like. Occasional exposure to communicable diseases and infection when working with patients.
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0 Utilization Review Technician jobs found in Canton, MI area