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  • 3000 Getwell Road
    Memphis, TN 38118

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Utilization Review Specialist

Delta Medical Center • Memphis, TN

Posted 30 days ago

Job Snapshot

Healthcare - Health Services
Professional Services

Job Description

Establishes and maintains contracts with managed care companies and requests rate increases when deemed appropriate.

Establishes contact with insurance and managed care companies and verifies treatment benefits.

Collects and records all information necessary for admission and extended stay review.

Reviews admission data to determine medical necessity and appropriateness of admission based upon approved criteria and standards.

Conducts random continuing-stay reviews to ensure patients in treatment require and are benefiting from the services they are receiving.

Interfaces with other departments in matters of review decisions, discharge planning and fiscal communication.

Communicates with insurance and managed care companies to inform them of diagnoses and health status of patients.

Notifies psychiatrists and other clinical staff of need for pre-certification and clinical reviews.

Sends requested medical records to insurer on a timely basis and follows up to make sure they are received.

Assists patient account representatives to ensure that the billing and collection process proceeds in a timely, efficient manner.

Reviews over / under utilization of facility resources.

Job ID: 5af27dfc0bf94362b1d9ec690d51c1b9
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