Utilization Review Specialist. Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. First Name. There are over 2,671 utilization review specialist careers waiting for you to apply! Free, fast and easy way find a job of 1.468.000+ postings in Texas and other big cities in USA. ... Find out what salary a Utilization Review Specialist in Riverside, CA will earn. Created detailed documentation of assessment and insurance benefit verification. All pre-certifications and concurrent reviews for all managed care. Create a Visual Resume. Responsible for ensuring that Client care is coordinated and managed appropriately daily. Headline : To obtain a position as a team-player in a people-oriented organization where can maximize customer-service experience in a challenging environment to achieve the corporate goals. Skills : Problem Solving Skills, Technical Skills. Led educational groups and lectures within a hospital setting to expand awareness of behavioral health symptoms and issues. Stayed knowledgable of our intake procedures and admission criteria Skills Used LPN. Responsibilities shown on sample resumes of Utilization Review Nurses include referring cases to medical directors where appropriate, and requesting additional information to perform thorough medical necessity assessments. Sent letters to members and providers as required. Recorded client information on special flow sheets, accurately indicating behaviors, mood, and progress. Worked closely with our billing department as well as the credentialing officer for at corporate Accomplishments. Worked with the clinical/medical team to ensure, that the care manager's questions and concerns are documented in the clinical record. Scheduled appointments, collected co-payments for behavioral health services, and coded client charts to documents sessions and finances received. Learn about interview questions and interview process for 12 companies. Planned and completed psychosocial assessments and admission logistics for behavioral health outpatient services. Established new procedures for our UR department regarding changes to the Medicaid changes. Responsible for consulted with insurance companies and clinical teams to evaluate appropriateness and level of care for complex or difficult cases. Prepared notification letters to initiate appeals processes. Assisted risk management to prevent and reduce litigation for the entire hospital. Email. Obtained insurance coverage for behavioral health services. Managed financial constraints, wrote appeals for reimbursement and assisted in the quality assurance process. Reviewed ineligible rider reports and medical necessity forms. Please provide a type of job or location to search! Co-facilitated educational series for the nursing department known as psychiatric Grand Rounds. Diligent Utilization Review Nurse ensuring that patients get the appropriate level of medical care. Utilization Review Specialist. Communicated significant findings, including potential risk improvement issues to the UR Manager or VP of Quality Assurance as indicated in a timely manner. Contacted insurance companies when needed for daily inhouse reviews. Do you need the best Utilization Review resume? For example, 14.4% of Utilization Review Coordinator resumes contained Utilization Review as a skill. Create a Visual Resume. Utilization Review Specialist. How to write Experience Section in Nurse Resume, How to present Skills Section in Nurse Resume, How to write Education Section in Nurse Resume. A utilization Review Specialist is hired to provide quality assurance to patients within medical fields. See salaries, compare reviews, easily apply, and get hired. Skills : Medical Terminology, Medical Insurance, Excellent Interpersonal Skills. Answered an average of 30 calls per day by addressing insurance inquiries, reviewing cases and providing benefit information. Summary : To utilize skills in direct clinical care, case management services and business administration to promote community and organizational development. Summary : To obtain a challenging, rewarding position in a health care facility that will enable to use strong passion for helping others, customer service skills, educational background. Maintained regular communication with the clinical team. Skills : Utilization Review, Discharge Planning. Managed denials and conducted doctor reviews to maintain the highest level of care. New utilization review specialist careers are added daily on SimplyHired.com. This cover letter was written by ResumeMyCareerâs staff of professional resume writers, and demonstrates how a cover letter for a Case Management â Utilization Review Oversight Cover Letter Sample should properly be created. Search and apply for the latest Utilization review specialist jobs in Albuquerque, NM. Skills : Management, Problem Solving Skills. Specialize in finding a balance between the fiscal needs of the hospital or medical facility and the care needs of each patient. Responsible for all hospital readmission assessments of patients readmitted with thin 3o days. Skills : Interpersonal Skills, Answering Phones. ... Find out what salary a Utilization Review Specialist in Wilmington, NC will earn. Utilization Review Specialist. Utilization Review Specialist. Experienced in Psychiatric and Medical-Surgical Case Management. Communicated with the clinical staff when issues arise with their clients. Trained new Utilization Review staff on InterQual(TM) standards. Competitive salary. Ensured that care and services are delivered appropriately and for the supervision of personnel. 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