Utilization Review Specialist

We are seeking a highly motivated Utilization Review Specialist to join our team at Henry Ford Health System. This position plays a critical role in ensuring the efficient and effective use of healthcare resources for our patients. As a Utilization Review Specialist, you will work closely with interdisciplinary teams to review and analyze medical records, assess treatment plans, and make recommendations for appropriate utilization of services. The ideal candidate will have a strong understanding of healthcare regulations and reimbursement processes, as well as excellent communication and critical thinking skills. Join us in our mission to provide high-quality, compassionate care to our patients.

1. Conduct thorough and timely reviews of medical records to ensure appropriate utilization of healthcare resources.
2. Collaborate with interdisciplinary teams to analyze treatment plans and make recommendations for necessary changes.
3. Maintain a strong understanding of healthcare regulations and reimbursement processes to ensure compliance.
4. Communicate effectively with healthcare providers, insurance companies, and other stakeholders to gather necessary information and resolve any issues.
5. Identify opportunities for improvement in utilization of services and make recommendations for process enhancements.
6. Utilize critical thinking skills to assess and evaluate patient needs and make appropriate recommendations for care.
7. Ensure accurate and timely documentation of utilization review activities in accordance with company policies and procedures.
8. Stay up-to-date on industry trends and changes in regulations related to utilization review.
9. Participate in training and development opportunities to enhance knowledge and skills.
10. Act as a resource for colleagues and provide guidance on utilization review processes and procedures.
11. Collaborate with insurance companies and other payers to obtain authorization for services.
12. Maintain confidentiality and adhere to all HIPAA regulations in handling patient information.
13. Uphold the mission and values of Henry Ford Health System in all interactions with patients, colleagues, and stakeholders.
14. Attend meetings and participate in projects related to utilization review and healthcare resource management.
15. Provide excellent customer service to patients and their families, addressing any concerns or questions related to utilization review.

According to JobzMall, the average salary range for a Utilization Review Specialist in Jackson, MI, USA is $51,000 - $66,000 per year. This may vary depending on the specific job duties, level of experience, and the employer.

The Henry Ford Health System is a comprehensive, integrated, non-profit health care organization in Metro Detroit. The corporate office is at One Ford Place, Detroit, Michigan. Henry Ford established the health system in 1915, and it is currently run by a 15-member board of trustees.