| Medical Utilization Review Specialist II Job Description |
 |
| The following is a full job description for Medical Utilization Review Specialist II. Here are the requirements and responsibilities for Medical Utilization Review Specialist II along with statistics. If after reading this page you determine that Medical Utilization Review Specialist II is not the position you are looking for, you may want to try one of these similar titles: Medical Utilization Review Specialist I, Medical Utilization Review Specialist III, Medical Utilization Review Manager, Medical Utilization Review Supervisor, Medical Utilization Review Director, Medical Utilization Review Senior Manager, Dental Utilization Review Analyst, Utilization Review Coordinator, Utilization Review Technician |
|
| Requirements and Responsibilities For Medical Utilization Review Specialist II |
| 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 moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. Typically requires 1-3 years of related experience. |
| |
|
| Also referred to as: Healthcare Utilization Review Specialist II, Medical Utilization Review Coordinator II, Medical Utilization Review Tech II, Medical Utilization Reviewer II |
|
| Similar Jobs: Medical Utilization Review Specialist I, Medical Utilization Review Specialist III, Medical Utilization Review Manager, Medical Utilization Review Supervisor, Medical Utilization Review Director, Medical Utilization Review Senior Manager, Dental Utilization Review Analyst, Utilization Review Coordinator, Utilization Review Technician |
|
| Level of Education: Medical Utilization Review Specialist II Salaries with No Diploma, Medical Utilization Review Specialist II Salaries with a High School Diploma or Technical Certificate, Medical Utilization Review Specialist II Salaries with an Associate's Degree, Medical Utilization Review Specialist II Salaries with a Bachelor's Degree, Medical Utilization Review Specialist II Salaries with a Master's Degree or MBA, Medical Utilization Review Specialist II Salaries with a JD, MD, PhD or Equivalent |
|
|
| Industries: Business Services, Edu., Gov't. & Nonprofit, Financial Services, Healthcare, Insurance | |
