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Licensed Utilization Review Specialist
A company is looking for a Utilization Review Specialist. Key Responsibilities Provide clinical support for denial management and clinical workflows within the patient financial service department Review medical records and prepare clinical appeals related to medical necessity and authorization denials Collaborate with multiple departments to improve processes and provide education for denial prevention Required Qualifications, Training, and Education Graduate from an accredited practical nursing program as a Licensed Practical Nurse (LPN); Registered Nurse (RN) preferred Five years of experience in a clinical setting required, with hospital experience preferred Preference for individuals with experience in utilization or with CPT/ICD knowledge Currently holds an unencumbered LPN license with State Nursing board and/or possesses multi-state licensure privileges
A company is looking for a Utilization Review Specialist.
Key Responsibilities
Provide clinical support for denial management and clinical workflows within the patient financial service department
Review medical records and prepare clinical appeals related to medical necessity and authorization denials
Collaborate with multiple departments to improve processes and provide education for denial prevention
Required Qualifications, Training, and Education
Graduate from an accredited practical nursing program as a Licensed Practical Nurse (LPN); Registered Nurse (RN) preferred
Five years of experience in a clinical setting required, with hospital experience preferred
Preference for individuals with experience in utilization or with CPT/ICD knowledge
Currently holds an unencumbered LPN license with State Nursing board and/or possesses multi-state licensure privileges