Utilization Review Specialist

Your job is more than a job General Duties Supports LCMC Health's mission of delivering exceptional patient care by ensuring the appropriate utilization of healthcare services through timely and accurate medical necessity reviews. Serves as a collaborative liaison between physicians, hospital departments, physician advisors, and third-party payers to facilitate appropriate patient status determinations and authorization processes. Performs pre-certification, concurrent, discharge, retrospective, and appeal reviews, including peer reviews and eligibility verification when appropriate. Applies standardized clinical criteria and regulatory guidelines to determine the appropriate level of care and patient classification, including inpatient, observation, and outpatient status.…