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Lifepoint Health
Overview
The specialist manages inpatient and outpatient authorizations, pre-certifications, and appeals to secure necessary patient coverage. They collaborate with interdisciplinary teams and physicians to ensure documentation requirements are met and denials are accurately reported.
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Compensation
Salary not listed
Posted
1 month ago
The Utilization Review Specialist manages inpatient and outpatient authorizations, including pre-certifications and re-certifications. They also coordinate with interdisciplinary teams and physicians to ensure documentation compliance and facilitate peer-to-peer reviews.
Riverview Health
The Clinical Case Manager is responsible for analyzing patient records, managing admission and concurrent reviews to prevent payer denials, and coordinating service approvals with payors within required timeframes. This role involves comparing medical records to care guidelines, communicating with the treatment team regarding length of stay and discharge readiness, and supporting utilization review processes including appeals and peer reviews.
3 months ago
