We are GatewayRegional Medical Center
Our mission is to provide compassionate, high-quality healthcare services to our community, promoting wellness and healing through innovative treatments, advanced technology, and a dedicated team of professionals. We are committed to fostering a culture of respect, integrity, and excellence, ensuring that every patient receives personalized care in a safe and nurturing environment. Together, we strive to enhance the health and well-being of those we serve and to be a trusted partner in their journey to better health.
Position Overview:
The Utilization Review Specialist RN assumes responsibility and accountability for admission and concurrent reviews to ensure the prevention of denials from all payers, as well as coordination and management of appeals for accounts deemed appropriate for appeal. This role supports compliance with payer, regulatory, and accreditation standards while promoting efficient utilization of healthcare resources and quality patient outcomes. The Specialist works collaboratively with interdisciplinary teams to identify denial trends, improve workflows, and ensure timely resolution of utilization review and appeals processes.
Specifics:
Education Qualifications:
Certification Qualifications:
Experience Qualifications:
Company Benefits:
Pay Range:
Disclaimer: Pay is determined based on various factors, including education level, years of experience, relevant certifications, and specific skills related to the position. The final compensation package will be discussed with Human Resources to ensure fairness and alignment with the candidate's qualifications.