Position Purpose
The Utilization Management Specialist is responsible for acute care concurrent review authorizations, denials tracking & reporting as well as appeals management. Acts as a resource and guide for physicians, the care delivery team, patients and their families throughout the continuum of available health care services by effectively monitoring, evaluating and integrating direct clinical and supportive services in order to achieve and maintain optimal patient health status and expectations. Ensures validity of accurate documentation of severity of illness (profiling) by working with the physician in the concurrent review process. May assist with patient care services care coordination, psychosocial groups and/or complete biopsychosocial.
What you will do
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