We are looking for a detailed-oriented Utilization Review (UR) Specialist to help us maximize patient care quality and ensure seamless insurance operations.
The UR Specialist evaluates patient medical records to ensure treatments meet clinical necessity and regulatory standards. You will serve as the primary bridge between our medical staff and insurance providers, facilitating timely care approvals and minimizing claim denials.
Other responsibilities include retrieving discharge documents on a daily basis from charts, faxing when applicable, and retrieving authorizations.
KEY RESPONSIBILITIES:
- Evaluate outpatient charts against established clinical criteria.
- Submit and track insurance authorization requests.
- Draft and submit clinical appeals for denied services.
- Communicate directly with insurance medical directors and case managers.
- Advise physicians and clinical staff on documentation requirements.
- Monitor utilization trends, denial rates, and approval timelines.
- Ensure adherence to Medicare, Medicaid, and private payer guidelines.
- Hours are Monday- Friday from 8:00am- 4:30pm
Requirements
- Active State of Nevada Licensed Practical Nurse (LPN) license required
- Minimum two (2) years of clinical experience, with 1+ years in utilization review or case management
- Knowledge of Nevada Payors required
- Strong Microsoft word and excel skills required
- Maintains confidentiality of patients at all times
Benefits
Eligible for benefits 1st of the month following one month of employment.
Desert Parkway offers competitive benefits to include:
- Health insurance
- Vision insurance
- Dental insurance
- 401K Retirement Plan
- Healthcare spending account
- Dependent care spending account
- PTO Plan with holiday premium pay
- Discounted cafeteria meal plan
- Life insurance (Supplemental Life, Term and Universal plans are also available)
- Short- and long-term disability (with additional buy-in opportunities)