What are the responsibilities and job description for the Utilization Review Specialist (Flexi) position at Preferred Home Health Care & Nursing Services?
The Utilization Review Specialist supports the organization’s utilization management by conducting routine admission, concurrent, and retrospective reviews based on established criteria and guidelines.
They collect, review, and document clinical information to determine medical necessity and appropriate resource use.
Complex cases requiring clinical judgment are escalated to an RN Utilization Review Specialist.
Key responsibilities include reviewing patient records, applying criteria, monitoring case documentation, communicating with providers and payers, and assisting with authorization tracking.
The role involves maintaining accurate records, supporting quality improvement, and participating in utilization management metrics reporting.
Qualifications include a healthcare license (e.g., LPN), with at least two years of clinical healthcare experience, and familiarity with utilization review processes.
Preferred certifications include utilization or case management. The position requires the ability to perform essential duties within a clinical work environment.
They collect, review, and document clinical information to determine medical necessity and appropriate resource use.
Complex cases requiring clinical judgment are escalated to an RN Utilization Review Specialist.
Key responsibilities include reviewing patient records, applying criteria, monitoring case documentation, communicating with providers and payers, and assisting with authorization tracking.
The role involves maintaining accurate records, supporting quality improvement, and participating in utilization management metrics reporting.
Qualifications include a healthcare license (e.g., LPN), with at least two years of clinical healthcare experience, and familiarity with utilization review processes.
Preferred certifications include utilization or case management. The position requires the ability to perform essential duties within a clinical work environment.