Utilization Review Specialist
: Job Details :

Performs admission and concurrent stay medical record review to determine appropriateness of admission, continued stay, and setting. Follows patient throughout hospitalization collaborating with attending physician and other health care providers. Communicates with third party payors to obtain authorization. Contributes to appropriate throughput and length of stay. Assists with denial management. Reviews physician medical record documentation and consults with physicians regarding completeness. Minimum Qualifications Minimum Education: ADN, Diploma Nursing Degree, or Bachelor of Science in Nursing Minimum Years of Experience: 3 Years of experience in an acute care hospital setting Substitutable Education & Experience: None. Required Certifications/ Licensure: Registered Nurse currently licensed in the State of South Carolina Required Training: None. Essential Functions Works in a cooperative manner, which fosters favorable relations between employees and patients, patients' families, v...Specialist, Health, Medical, Physician, Healthcare, Patient, Information