MedStar Health’s Washington Hospital Center
Utilization Review Tech
MedStar Health’s Washington Hospital Center, Baltimore, Maryland, United States, 21276
Overview
MedStar Health is looking for a Utilization Review Technician to join our team at MedStar Harbor Hospital.
The Utilization Review Technician collaborates with the multidisciplinary team to meet individualized patient outcomes, performing admission and concurrent reviews based on approved criteria and insurance coverage.
Primary Duties and Responsibilities
Participates in ongoing professional enrichment and educational opportunities, collaborating with the multidisciplinary team to meet patients’ health needs in a high quality, cost‑effective manner.
Collects quality improvement data in accordance with approved indicators and collaborates with physician advisors and attending physicians to resolve acuity problems.
Evaluates concurrent and retrospective denials, generates appeal letters based on clinical severity, and facilitates discharge planning and appointment scheduling.
Implements denial‑avoidance strategies, issues noncoverage letters to attending physicians, and collaborates with Social Work, physicians, and the multidisciplinary team to revise discharge plans.
Performs admission and concurrent reviews to determine necessity for acute care, interacts with third‑party payer reviews to facilitate appropriate care, completes documentation, and serves as a resource to staff on utilization review/management.
Minimum Qualifications
Associate’s degree in Psychiatry or related field.
1‑2 years’ experience in utilization/discharge planning.
5‑7 years’ clinical experience in an acute care setting preferred.
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The Utilization Review Technician collaborates with the multidisciplinary team to meet individualized patient outcomes, performing admission and concurrent reviews based on approved criteria and insurance coverage.
Primary Duties and Responsibilities
Participates in ongoing professional enrichment and educational opportunities, collaborating with the multidisciplinary team to meet patients’ health needs in a high quality, cost‑effective manner.
Collects quality improvement data in accordance with approved indicators and collaborates with physician advisors and attending physicians to resolve acuity problems.
Evaluates concurrent and retrospective denials, generates appeal letters based on clinical severity, and facilitates discharge planning and appointment scheduling.
Implements denial‑avoidance strategies, issues noncoverage letters to attending physicians, and collaborates with Social Work, physicians, and the multidisciplinary team to revise discharge plans.
Performs admission and concurrent reviews to determine necessity for acute care, interacts with third‑party payer reviews to facilitate appropriate care, completes documentation, and serves as a resource to staff on utilization review/management.
Minimum Qualifications
Associate’s degree in Psychiatry or related field.
1‑2 years’ experience in utilization/discharge planning.
5‑7 years’ clinical experience in an acute care setting preferred.
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