Utilization Specialist

The Pavilion at Williamsburg Place

Williamsburg, Virginia, US
Admission and continued stay reviews
Insurance and hmo communication
Denial appeals management
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which meets the daily deadlines to obtain authorizations and complete other pertinent processes

Job Summary

  • The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which meets the daily deadlines to obtain authorizations and complete other pertinent processes.
  • Communicates effectively with insurance companies, health maintenance organization (HMOs) and other similar entities for approval of initial or additional inpatient days for treatment.
  • The Pavilion at Williamsburg Place offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications.

Matching Summary

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which meets the daily deadlines to obtain authorizations and complete other pertinent processes.

Skills & Requirements

Must-have

  • Admission and continued stay reviews
  • Insurance and HMO communication
  • Denial appeals management
  • Benefit verification
  • Staff training on documentation

Nice-to-have

  • Collaborative team environment
  • Patient advocacy
  • Continuous improvement focus

Key Requirements

  • Graduation from approved/accredited school of nursing or Bachelor's degree
  • Two or more years direct clinical experience
  • Current LPN or RN licensure
  • Clinical professional license or certification

Work Rights

Not specified

Tailored Resume

Cover Letter