Utilization Review and Reimbursement Specialist

About This Opportunity

We are representing a confidential rehabilitation healthcare organization in the United States. Our talent team is seeking a Utilization Review and Reimbursement Specialist to join a mission-driven organization that helps patients rebuild their lives through comprehensive rehabilitation services.

This role coordinates utilization management and medical record review to ensure patients receive appropriate access to inpatient rehabilitation services while navigating complex insurance authorization processes.

Responsibilities

• Coordinate utilization management review functions at preadmission, admission, continued stay, and discharge stages according to the Hospital Utilization Review Plan
• Analyze insurance, governmental, and accrediting agency standards to determine criteria for admissions, treatment, and length of stay
• Manage completion of prior authorization and recertification requests with third-party insurers as part of the reimbursement process
• Conduct complex case reviews to determine inpatient admission criteria eligibility
• Implement strategies to navigate the insurance authorization process efficiently and reduce barriers to care
• Drive denial management strategies through robust data capture and documentation of activities and outcomes
• Review medical charts and compose insurance appeal letters on behalf of patients
• Develop and maintain relationships with key payers to improve patient access to inpatient services
• Support departmental and hospital-wide educational activities related to utilization review
• Contribute to quality improvement initiatives by identifying problems and seeking solutions

What We're Looking For

Required Qualifications:

• Degree in nursing, social work, physical therapy, occupational therapy, speech therapy, or equivalent field
• Valid driver's license with no restrictions
• Demonstrated competence in spelling, grammar, composition, and accurate typing
• Strong interpersonal skills with ability to interact appropriately with professional staff
• Proficiency with personal computers and medical records/admissions/utilization management applications
• Excellent customer service orientation with ability to handle confidential information discretely

Preferred Qualifications:

• Minimum 2 years of experience in Utilization Management
• Certification as a Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA)

Physical Requirements: Majority of time spent in stationary position using keyboard; occasional movement around work location; occasional lifting up to 10 pounds.

How We Work With You

Get A Job.ai serves as the exclusive recruiting partner for this confidential healthcare client. When you apply through our platform at getajob.ai, one of our specialized healthcare recruiters will review your qualifications and conduct an initial screening. If there's a strong match, we will submit your profile to our client for consideration and guide you through their interview process.

Please do not attempt to contact the employer directly, as all applications must come through Get A Job.ai to be considered.

Pay

Compensation details will be discussed with qualified candidates during the screening process.

Equal Employment Opportunity: Get A Job.ai is committed to inclusive hiring practices. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, genetic information, veteran status, disability, or other legally protected characteristics.