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The Utilization Review Representative is responsible for handling and coordinating Administrative functions of the utilization review process. This is a non-clinical position, and the UR Representative is not responsible for and is prohibited from conducting any utilization management activities that require clinical information interpretation.
Responsibilities
- Receives, screens and manages mail, faxes and calls.
- Reviews service request for completeness of information.
- Collection and data entry of structured clinical data (including diagnosis, diagnosis codes, procedures, procedure codes).
- Assigns reviews to Utilization Review Nurse
- Assists with written determination letter communications via fax, e-mail or written mail under.
- Provides customer service functions.
- Maintains confidentiality and security in all aspects of performance.
- Performs other related duties incidental to the work described herein.
- Follow established state and federal medical bill review rules and regulations.
Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic protected by law.
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