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
Current LPN, RN or other Clinical Licensure and/or master’s degree required.
Minimum two (2) years of clinical experience, with 1+ years in utilization review or case management required
Knowledge of Nevada Payors required
Previous experience working in behavioral healthcare strongly preferred
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)