Role and Responsibilities

The Utilization Review Specialist is responsible for performing utilization review activities including technical audit of assigned patient electronic medical records. This position is critical to the organizations Quality Assurance and Compliance programs to ensure HCR is providing safe and quality care by adhering to federal, state, and payer regulations. This position works in collaboration with the authoring clinicians of reviewed records. Requires collaboration with staff development and clinical management to report identified trends.

This is a hybrid position requiring onsite for orientation and quarterly education at each region.

Essential Functions

• Perform detailed technical audit of CHHA and LHCSA records:

• Conduct review of clinical documentation in patient medical record to ensure compliance with agency policies and procedures and regulatory guidelines.

• Review identified areas of patient medical record for completeness and consistency.

• Enter review findings in an electronic database.

• Meet or exceed established productivity and timeliness expectations.

• Work as a team with co-workers to meet departmental and agency goals.

• Collaborate with clinical management, staff development, quality and compliance departments to inform of findings of audits, outcome measurements and notify of trends and potential education needs.

• Conduct education sessions with staff (1:1 or group setting) to inform of documentation deficiencies and provide corrective action as needed.

• Provide staff training for new Utilization Review initiatives and monitors the performance of assigned branches.

• Participate in the development of company Utilization Review guidelines and protocols.

• Keep abreast of pertinent industry utilization, regulatory and OASIS practice standards.

• Establish and promote positive, ongoing communication with company personnel.

• Maintain current knowledge and certification (when applicable) in areas of responsibility.

• Provide onsite education quarterly to review quarterly audit findings at each region.

• Other duties as assigned.

This job description reflects managements assignment of essential functions; and nothing in this herein restricts managements right to assign or reassign duties and responsibilities to this job at any time.