Utilization Reviewer - Care Management - Per Diem / Flex - Days at Baptist Hospitals of Southeast Texas
Baptist Hospitals of Southeast Texas · Beaumont, United States Of America · Onsite
- Junior
- Office in Beaumont
We are looking to add top talent to our Baptist Hospitals of Southeast Texas team.
Join us in performing Sacred Work!
Competitive benefits are offered including:
Matched Retirement Plan
Paid Time Off
Comprehensive Benefit Plan – Medical, Dental, Vision and Much More!
Bonus Potential
Summary/Objective
Under the supervision of the Director of Care Management, the Utilization Reviewer is responsible for assisting in the coordination and facilitation of the Utilization Review and Discharge Planning processes carried out by the Care Management Department. The Utilization Reviewer will serve as support for the Case Management team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while providing timely and accurate information to payors.
Essential Job Duties
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Support timely bill release, including review of assigned billing codes.
Deliver required regulatory notices (e.g., IM, MOON) as needed.
Ensure timely and accurate observation charge entry for the Beaumont campus.
Communicate with payers and internal teams to support timely authorizations (e.g., peer-to-peer reviews, physician advisor referrals).
Assist with post-acute care coordination as needed.
Support the denials management process as assigned.
Required Education and Experience
High School diploma or equivalent
Required License/Certifications
N/A
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