| Medical Utilization Review Specialist I Job Description |
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| The following is a full job description for Medical Utilization Review Specialist I. Here are the requirements and responsibilities for Medical Utilization Review Specialist I along with statistics. If after reading this page you determine that Medical Utilization Review Specialist I is not the position you are looking for, you may want to try one of these similar titles: Medical Utilization Review Specialist III, Medical Utilization Review Specialist II, Medical Utilization Review Director, Medical Utilization Review Manager, Medical Utilization Review Supervisor, Medical Utilization Review Senior Manager, Utilization Review Coordinator, Medical Affairs Specialist IV, Utilization Review Technician |
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| Requirements and Responsibilities For Medical Utilization Review Specialist I |
| Responsible for evaluating proposed and/or delivered healthcare services to determine if the services meet established health plan coverage guidelines. Receives, reviews, and acts on pre-authorization requests from service providers for medical procedures, treatments, admissions, and medications. Reviews patient and clinical information to ensure compliance with established utilization review guidelines. Refers more complex requests and those that need clinical review to a medical reviewer. Requires a high school diploma or equivalent. Typically reports to a supervisor. Works under the close direction of senior personnel in the functional area. Possesses a moderate understanding of general aspects of the job. May require 0-1 year of general work experience. |
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| Also referred to as: Healthcare Utilization Review Specialist I, Medical Utilization Review Coordinator I, Medical Utilization Review Tech I, Medical Utilization Reviewer I |
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| Similar Jobs: Medical Utilization Review Specialist III, Medical Utilization Review Specialist II, Medical Utilization Review Director, Medical Utilization Review Manager, Medical Utilization Review Supervisor, Medical Utilization Review Senior Manager, Utilization Review Coordinator, Medical Affairs Specialist IV, Utilization Review Technician |
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| Level of Education: Medical Utilization Review Specialist I Salaries with No Diploma, Medical Utilization Review Specialist I Salaries with a High School Diploma or Technical Certificate, Medical Utilization Review Specialist I Salaries with an Associate's Degree, Medical Utilization Review Specialist I Salaries with a Bachelor's Degree, Medical Utilization Review Specialist I Salaries with a Master's Degree or MBA, Medical Utilization Review Specialist I Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Financial Services, Healthcare, Insurance | |
