The UR Specialist reviews and monitors patients’ utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties include providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency of medical services and procedures. + Performs concurrent and retrospective reviews on all patients. Monitors level and quality of care. + Responsible for the proactive management of patients with the objective of improving quality outcomes and decreasing costs. + Evaluates and provides feedback to treating physicians regarding a patient’s discharge plans and available covered services, including identifying alternative levels of care that may be covered. + Monitors all utilization reports to assure compliance with reporting and turnaround times. + Addresses care issues with the Director of Clinical Services and Chief Medical Officer/Medical Director as appropriate. + Coordinates an interdisciplinary approach to support continuity of care. + Provides utilization management, transfer coordination, discharge planning, and issuance of all appropriate authorization for covered services as needed. + Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum. + Clarifies health plan medical benefits, policies and procedures for members, physicians, staff, contract providers, and outside agencies. Requirements Requirements + Bachelor's degree in Social Work or related field required. + Clinical Licensure in the State of Nevada preferred, no required + Knowledge of medical terminology, medical records, and appropriate medical coding system. + Working knowledge with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint). + Maintains confidentiality of patients at all times. Benefits We proudly offer the following benefits available first of the month following just one month of employment: + Competitive rates + Flexible schedules + Tuition reimbursement + Comprehensive package of benefits to include: + Medical + Dental + Vision + Life, Pet, Identity Theft Insurance + 401k + Generous paid time off + Short Term and Long Term Disability