Utilization Review Specialist

We are seeking a highly motivated and detail-oriented Utilization Review Specialist to join our team at Henry Ford Health System. In this role, you will play a crucial part in ensuring the quality and efficiency of our healthcare services by conducting thorough reviews of patient medical records and determining appropriate levels of care. Your expertise in utilization review and strong communication skills will be essential in collaborating with healthcare providers and insurance companies to optimize patient care and reimbursement. The ideal candidate will have a background in healthcare, exceptional critical thinking abilities, and a passion for improving the delivery of healthcare services. Join us in our mission to provide exceptional care to our patients and make a positive impact in the healthcare industry.

1. Conduct comprehensive reviews of patient medical records to assess the appropriateness and effectiveness of healthcare services provided.
2. Utilize knowledge of medical terminology, healthcare regulations, and insurance policies to determine appropriate levels of care for patients.
3. Collaborate with healthcare providers and insurance companies to optimize patient care and ensure timely reimbursement for services.
4. Communicate effectively with healthcare team members, insurance representatives, and patients to gather necessary information and resolve any discrepancies in medical records.
5. Identify and report any quality or compliance issues related to healthcare services and work with the appropriate stakeholders to address and resolve them.
6. Maintain accurate and detailed documentation of all review activities and outcomes.
7. Utilize critical thinking skills to analyze and interpret complex medical information and make sound decisions regarding the appropriateness of care.
8. Stay updated on changes in healthcare regulations and insurance policies to ensure compliance and accuracy in utilization review processes.
9. Participate in training and education programs to enhance knowledge and skills related to utilization review and healthcare delivery.
10. Contribute to the development and implementation of quality improvement initiatives to enhance the delivery of healthcare services.
11. Work closely with interdisciplinary teams to ensure the coordination and continuity of care for patients.
12. Maintain confidentiality and adhere to ethical standards in handling sensitive patient information.
13. Act as a resource for healthcare providers and insurance representatives regarding utilization review processes and procedures.
14. Demonstrate a strong commitment to providing exceptional care to patients and promoting positive change in the healthcare industry.
15. Collaborate with other members of the utilization review team to share knowledge and best practices and continuously improve processes.

According to JobzMall, the average salary range for a Utilization Review Specialist in West Bloomfield Township, MI, USA is between $54,000 and $72,000 per year. This can vary depending on the specific company, experience level, and other factors.

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.