Utilization Review Specialist in Tamarac, Florida, United States
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HCA Healthcare

Utilization Review Specialist

Tamarac, FL, United States
PRN/Per Diem • PRN Status/As Needed Schedule
Case Management   Job ID: 30682
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Description

Introduction

Do you have the career opportunities as a Utilization Review Specialist in your current role? We invest in We have an exciting opportunity for you to join HCA Healthcare which is a part of the nation’s leading provider of healthcare services!

Benefits

We are committed to providing our employees with the support they need. At HCA Healthcare, we offer eligible colleagues an attractive benefit package that includes medical, wellbeing, dental and vision benefits along with some unique benefits including:

  • Medical, Dental, Vision, Life Insurance and Flexible Spending
  • Paid Time Off (PTO) and Personal Leave
  • 401K(100% annual match - 3% to 9% of pay based on years of service)
  • Academic Assistance and Reimbursements for Tuition and Student Loans
  • Employee Discounts including Tickets, Retail, Mental Health Apps, Education Apps, Identity Theft Protection etc.
  • Home, Auto, and Pet Insurance
  • Employee Stock Purchase Program (ESPP)
  • Short Term & Long Term Disability coverage
  • Adoption Assistance
  • Legal Benefits and lots more!

 Would you like to unlock your potential with a leading healthcare provider dedicated to the growth and development of our colleagues? Join the HCA Healthcare family! We will give you the tools and resources you need to succeed in our organization. We are looking for an enthusiastic Utilization Review Specialist to help us reach our goals. Unlock your potential!

Job Summary and Qualifications

As a Utilization Review Specialist, this position will focus on initial and continued stay utilization review as needed for authorization procurement and mitigation of concurrent denials. This involves assessment of the medical records for appropriateness, level of care provided, including assessment of treatment modalities, medications, services and application of treatment protocols. Remain current with HCA education standards and guidelines, such as annual InterQual education, ongoing Midas education and Midas worklist rules. Maintain nursing/SW licensure for assigned geographical market.

What you will do:

  • Conduct medical record review, validate admission status order, conduct a medical necessity review and provide clinical information to payor
  • Document all efforts to gain authorization and payor communications, confirming all days authorized or denied and document in Midas
  • Utilize critical thinking skills to review and apply medical necessity criteria
  • Proficient in application and use of InterQual
  • Analyze documentation of clinical care from the electronic medical record

 What you will need: 

  • Possess a Bachelor’s Degree in Nursing or Master’s Degree in Social Work or Counseling, and related licensure for the industry field as appropriate.
  • Experience conducting utilization reviews in a behavioral health setting preferred.
  •  1-3 years’ experience in a behavioral healthcare setting performing clinical assessments or in a clinical treatment setting, required.
  • Licensure preferred as a mental health professional, such as Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), or Licensed Marriage and Family Therapist (LMFT), Licensed Mental Health Clinician (LMHC), or RN license (RN requires at least 3 years in an applicable mental health environment).
  • Registered Nurse, or Marriage and Family Counselor, or License Clinical Social Worker (LCSW), or Clinical Social Worker (MSW), or Bachelor’s Degree, or Master’s Degree

 HCA Healthcare (Corporate), based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleled resources and opportunities to reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education and career advancement opportunities, every person has a solid foundation for success. Nashville is also home to our Executive Development Program, where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry.

 HCA Healthcare has been named one of the World's Most Ethical Companies by Ethisphere Institute for over a decade. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

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Details

Case Management
PRN/Per Diem • PRN Status/As Needed Schedule

About HCA Healthcare

What matters most to our diverse and talented colleagues is giving people the absolute best healthcare in the most compassionate way possible.

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