Utilization Review Specialist

Our take on this role

About this role

Coordinate between hospital inpatient and ambulatory services and managed care organizations. Responsibilities include obtaining care authorizations, reviewing medical necessity and monitoring patient benefits.

What could you bring from clinical work?

• Nurses: Your experience interpreting clinical records and documenting care needs could help with reviewing medical necessity.
• Social workers: Documenting psychosocial needs and coordinating access to services may help you obtain authorization for all levels of care.
• OTs, PTs and SLPs: If you've documented medical necessity for skilled services, that experience could help you review medical necessity and obtain care authorizations.

Full job description from St. Vincent's Hospital Westchester

The Utilization Review Specialist's primary role is the liaison between the hospitals inpatient and ambulatory services and the managed care organizations. The UR specialist is responsible for a wide range of administrative responsibilities including obtaining authorization for all levels of care, medical necessity review, monitoring of patients benefits and is knowledgeable of SJMC contractual agreements. The UR specialist works closely with numerous depts. within the hospital, including the inpatient and outpatient treatment teams, Evaluation and Referral, Benefits and Patient Accounts.

One year experience in Healthcare and/or Managed Care Setting required.

Undergraduate/Bachelor Degree (required) in Human or Health Services (preferred)

Pay: $55,000 - $60,000