Utilization Review Specialist Job Vacancy in Harmon Hospital Las Vegas, NV 89119 – Latest Jobs in Las Vegas, NV 89119

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Full Details :
Company Name : Harmon Hospital
Location : Las Vegas, NV 89119
Position : Utilization Review Specialist

Job Description : BENEFITS:
All of our employees are valued and receive a competitive hourly rate; full time team members are also offered a comprehensive benefit package which includes:

Medical, Dental, Vision, Life and Disability Insurance/ Flexible Spending Accounts
Tuition Reimbursement Nursing Loan Repayment Programs
401(k)
Paid Time Off
New Pet Insurance Discount available
DailyPay option available! – Get your pay, when you need it.
Purchasing Power – online purchase/payroll deduction
Tickets at Work – entertainment ticket discounts
Employee Assistance Plan – easy-to-use services to help with everyday challenges of life (available for all employees and their families)
Helping Friends Foundation – our employees’ hardship/crisis fund
MetLife Auto and Home Insurance – employee discount available – payroll deduction!
In-facility education programs and more!

Harmon Hospital- 2170 East Harmon Avenue, Las Vegas, NV 89119

Harmon Hospital is a 118-bed acute care hospital with 2 skilled nursing home beds located in Las Vegas, Nevada. Our team provides personalized acute care and skilled nursing services designed to consider and address the needs of patient with both behavioral health and medical conditions. Our campus focuses on the unique needs patient have when challenged with trying to find and engage services within one care setting.

Equal Opportunity Employer. M/F/Vets/Disabled. Drug-free/Smoke-free work environment.

POSITION SUMMARY:
The Utilization Review Specialist is responsible for ensuring the necessity and appropriateness of care, effective benefit management and coordination, as well as positive communications and relationship building activities with all customers.

DUTIES RESPONSIBILITIES:

Maintains significant contact with referring healthcare professional associations, nursing service personnel, medical staff, patients, families, insurance representatives, and other staff.
Performs insurance verification and ongoing status of payment. Assists hospital business office with matters related to insurance reimbursement.
Completes cost/benefit analysis of treatment plans and negotiates appropriate rates.
Coordinates and communicates with all clinical professionals involved with patients.
Conducts himself/herself in a professional manner in compliance with unit and hospital policies.
Assists the billing department in appealing denials through the payer’s appeal process.
Understands the language of contracts and negotiates and/or renegotiates their terms, as necessary.
Determines alternative care options, performs cost-benefit analyses, and develops a treatment plan that effectively addresses the patient’s needs.
Monitors the patient’s clinical progress as well as that of the treatment plan.
Works with the marketing team on inquiries and/or referrals, as requested.
Collaborates with the attending physician and treatment team to facilitate patient conferences which develop, monitor and refine the treatment plan to achieve identified patient outcomes.
Facilitates effective team communication regarding new patients’ special needs and preliminary disposition plans.
Maintains daily contact with nursing units to identify patient needs related to diagnosis, treatment, prognosis, and projected date of discharge.
Works with physician and treatment team to review orders regarding consults, DME, and discharge plans to ensure compliance with the patient’s insurance company.
Maintains internal tracking documents and spreadsheets on a daily basis and/or as instructed.

QUALIFICATIONS REQUIREMENTS:

An Associate’s or Bachelor’s degree in a medical or health-related field healthcare related field is preferred. However, an extensive background in medical billing or health care quality assurance will be considered
Must have previous experience in medical utilization review
Must have a reliable source of transportation

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