Utilization Review Medical Records

Background in Behavioral Health, Medical, or Nursing settings Preferred for documentation familiarization.

• Conduct utilization review activities, including chart reviews and monitoring authorization requirements.
• Prepare and present findings during utilization review meetings.
• Collaborate with clinical tea ---------- mbers to ensure documentation supports medical necessity.
• Provide follow-up communication regarding denied authorizations or additional info requests.

Audit & Provider Feedback
• Assist with formal and informal audits of clinical documentation.
• Prepare summary reports based on audit findings.
• Communicate constructive, professional feedback to providers to support compliance and quality improvement.

Administrative & Technical Tasks
• Use Excel to prepare and manage logs, tracking sheets, and performance reports.
• Maintain organized workflows to ensure timely completion of record requests and UR tasks.
• Communicate professionally via email, messaging platforms, or video conference.
• Support other administrative or compliance-related tasks as needed.


Qualifications
• Required:
• Experience with Utilization Review or Medical Records Management
• Strong analytical skills and attention to detail
• Excellent written and verbal communication
• Proficiency with Microsoft Excel (sorting, filtering, basic formulas, tracking sheets)
• Strong organization and time-management skills
• Ability to handle confidential information appropriately
• Preferred:
• Background in Behavioral Health, Medical, or Nursing settings
• Familiarity with insurance authorization processes
• Knowledge of HIPAA compliance
• Experience working with EHR/EMR systems