Utilization Review Specialist

Lexington Health Inc

West Columbia, South Carolina, US
On-site
Medical record review
Third party payor communication
Interqual criteria
Performs admission and concurrent stay medical record review to determine appropriateness of admission, continued stay, and setting

Job Summary

  • Performs admission and concurrent stay medical record review to determine appropriateness of admission, continued stay, and setting.
  • Contributes to appropriate throughput and length of stay, assists with denial management, and reviews physician medical record documentation.
  • Lexington Health is committed to offering quality, cost-effective benefits choices for our employees and their families, including Day ONE medical, dental and life insurance benefits.

Matching Summary

Performs admission and concurrent stay medical record review to determine appropriateness of admission, continued stay, and setting.

Skills & Requirements

Must-have

  • medical record review
  • third party payor communication
  • InterQual criteria
  • regulatory compliance
  • denial management

Nice-to-have

  • cooperative manner
  • teamwork and harmonious relationships
  • service recovery process
  • receptiveness to change
  • positive working relationships

Key Requirements

  • Registered Nurse currently licensed in the State of South Carolina
  • 3 Years of experience in an acute care hospital setting
  • ADN, Diploma Nursing Degree, or Bachelor of Science in Nursing

Work Rights

Not specified

Tailored Resume

Cover Letter