Utilization Review Specialist - UnityPoint Health : Job Details

Utilization Management Addresses and monitors length of stay issues and level of care changes for compliance. Documents the case management plan to include: clinical needs, barriers to quality care, effective utilization of resources and pursues denials of payment and referrals in a timely, legible manner. Collects appropriate data, trends, analyzes and reports on patterns of care, possible avoidable delays in transition, variance from pathways and resource utilization. Revenue Cycle Communicates effecively with thrird party payers regarding authorization of stay, continued stay reviews, appeals and denial letters. Provides education and serves as a resource to the multidisciplinary team in regards to level of care and reimbursement issues. Documents within the electronic medical record including financial notations and letters when appropriate. Collects appropriate data, trends, analyzes and reports on patterns of care, possible avoidable delays in transition, variance from pathw...Specialist, Healthcare, Behavioral Health, Patient