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The UR Specialist reviews and monitors patients’ utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties include providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency of medical services and procedures.

+ Performs concurrent and retrospective reviews on all patients. Monitors level and quality of care.

+ Responsible for the proactive management of patients with the objective of improving quality outcomes and decreasing costs.

+ Evaluates and provides feedback to treating physicians regarding a patient’s discharge plans and available covered services, including identifying alternative levels of care that may be covered.

+ Monitors all utilization reports to assure compliance with reporting and turnaround times.

+ Addresses care issues with the Director of Clinical Services and Chief Medical Officer/Medical Director as appropriate.

+ Coordinates an interdisciplinary approach to support continuity of care.

+ Provides utilization management, transfer coordnation, discharge planning, and issuance of all appropriate authorization for covered services as needed.

+ Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.

+ Clarifies health plan medical benefits, policies and procedures for members, physicians, staff, contract providers, and outside agencies.

Requirements

+ Bachelor's degree in Social Work or related field required.

+ Clinical Licensure in the State of Nevada preferred.

+ Knowledge of medical terminology, medical records, and appropriate medical coding system.

+ Working knowledge with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint).

+ Maintains confidentiality of patients at all times.

Benefits

We proudly offer the following benefits available first of the month following just one month of employment:

+ Competitive rates

+ Flexible schedules

+ Tuition reimbursement

+ Comprehensive package of benefits to include:

+ Medical

+ Dental

+ Vision

+ Life, Pet, Identity Theft Insurance

+ 401k

+ Generous paid time off

+ Short Term and Long Term Disability