| Medical Utilization Review Specialist III Job Description |
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| The following is a full job description for Medical Utilization Review Specialist III. Here are the requirements and responsibilities for Medical Utilization Review Specialist III along with statistics. If after reading this page you determine that Medical Utilization Review Specialist III 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 II, Medical Utilization Review Manager, Medical Utilization Review Director, Medical Utilization Review Supervisor, Medical Utilization Review Senior Manager, Medical Affairs Specialist III, Dental Utilization Review Analyst, Utilization Review Coordinator |
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| Requirements and Responsibilities For Medical Utilization Review Specialist III |
| 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 independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. Typically requires 3-5 years of related experience. |
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| Also referred to as: Healthcare Utilization Review Specialist III, Medical Utilization Review Coordinator III, Medical Utilization Review Tech III, Medical Utilization Reviewer III |
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| Similar Jobs: Medical Utilization Review Specialist I, Medical Utilization Review Specialist II, Medical Utilization Review Manager, Medical Utilization Review Director, Medical Utilization Review Supervisor, Medical Utilization Review Senior Manager, Medical Affairs Specialist III, Dental Utilization Review Analyst, Utilization Review Coordinator |
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| Level of Education: Medical Utilization Review Specialist III Salaries with No Diploma, Medical Utilization Review Specialist III Salaries with a High School Diploma or Technical Certificate, Medical Utilization Review Specialist III Salaries with an Associate's Degree, Medical Utilization Review Specialist III Salaries with a Bachelor's Degree, Medical Utilization Review Specialist III Salaries with a Master's Degree or MBA, Medical Utilization Review Specialist III Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Financial Services, Healthcare, Insurance | |
