Utilization Review Specialist

Welcome to Henry Ford Health System, where our mission is to improve people's lives through excellence in the science and art of healthcare. We are currently seeking a Utilization Review Specialist to join our team. In this role, you will play a vital part in ensuring the efficient and appropriate use of healthcare services for our patients. As a Utilization Review Specialist, you will have the opportunity to collaborate with interdisciplinary teams to evaluate medical records, assess the medical necessity of treatments, and coordinate discharge planning. Join us and make a difference in the lives of our patients. To be successful in this role, you must possess a strong attention to detail, excellent communication and critical thinking skills, and a minimum of 2 years of experience in utilization management. If you are passionate about providing high-quality, patient-centered care, we invite you to apply for this exciting opportunity.

1. Conduct utilization reviews to evaluate the medical necessity, appropriateness, and efficiency of healthcare services provided to patients.
2. Collaborate with interdisciplinary teams to assess and review medical records, treatment plans, and discharge plans.
3. Ensure compliance with regulatory standards and guidelines in regards to utilization management.
4. Communicate with healthcare providers, insurance companies, and patients to gather necessary information for utilization reviews.
5. Identify and report any potential issues or concerns related to utilization management to appropriate parties.
6. Participate in quality improvement initiatives to enhance utilization management processes.
7. Utilize critical thinking skills to make evidence-based decisions regarding the utilization of healthcare services.
8. Maintain accurate and up-to-date documentation of utilization management activities.
9. Educate healthcare providers and staff on utilization management best practices and guidelines.
10. Keep abreast of changes in healthcare policies and regulations that may impact utilization management processes.
11. Work closely with insurance companies to ensure timely and accurate reimbursement for services provided.
12. Provide excellent customer service to patients, families, and other healthcare professionals.
13. Adhere to confidentiality and privacy regulations in handling patient information.
14. Attend and participate in meetings, trainings, and educational opportunities related to utilization management.
15. Collaborate with other Utilization Review Specialists to share knowledge and best practices.

According to JobzMall, the average salary range for a Utilization Review Specialist in Clinton Twp, MI, USA is between $48,000 and $70,000 per year. This range can vary depending on factors such as experience, education, and the specific company or organization the specialist is working for. Additionally, some specialists may also receive benefits such as health insurance, retirement plans, and bonuses, which can also impact their overall compensation.

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.