Responsibilities

The Utilization Review Clinician will conduct prior authorization reviews and/or continued stay reviews for post-acute care services, applying clinical guidelines and escalating cases as needed. They will approve services in compliance with health plan guidelines and contractual agreements, collaborate with case managers and physicians to ensure appropriate care transitions, participate in team meetings and educational activities, ensure compliance with standards, support payer programs, make benefit determinations, and coordinate benefits between various care areas. Additionally, they will utilize knowledge of resources to assist physicians and patients, and perform other job duties as assigned.