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 coordnation, 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 + Current LPN, RN or other Clinical Licensure and/or Master’s degree 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 A full benefits package is available the first of the month following just one (1) month of employment! Desert Parkway offers competitive benefits to include: + Medical insurance (three plans to choose from) + Dental insurance (two plans to choose from) + Vision insurance + 401K Retirement Plan + Healthcare spending account + Dependent care spending account + PTO Plan + Discounted cafeteria meal plan + Life insurance (including plans for spouse and children) + Short- and long-term disability (with additional buy-in opportunities) + Pet Insurance + Identity Theft Insurance