What is an Utilization Review Job?
An utilization review job is a position in the healthcare industry that involves reviewing medical records and treatment plans in order to ensure that they are appropriate, necessary, and cost-effective. The goal of this job is to make sure that patients receive the best possible care while also helping to control healthcare costs. Utilization review professionals may work for hospitals, insurance companies, or other healthcare organizations.
What Usually Do in This Position?
Utilization review specialists typically review medical records and treatment plans to ensure that they are medically necessary and appropriate. They may also work with healthcare providers to develop treatment plans that are more cost-effective, and may help to identify areas where cost savings can be achieved. In addition, they may help to develop policies and procedures for healthcare organizations, and may provide education and training to staff members.
Top 5 Skills for Position
- Strong analytical and critical thinking skills
- Excellent communication and interpersonal skills
- Knowledge of healthcare regulations and policies
- Ability to work independently and as part of a team
- Strong attention to detail and organizational skills
How to Become This Type of Specialist
To become an utilization review specialist, you typically need a bachelor's degree in healthcare administration, nursing, or a related field. Some employers may require a master's degree or other advanced degree. In addition, many employers prefer candidates who have experience working in healthcare or in a related field.
Average Salary
According to the Bureau of Labor Statistics, the median annual salary for medical and health services managers, which includes utilization review specialists, is $100,980. However, salaries can vary widely depending on the employer, location, and level of experience.
Roles and Types
There are a variety of roles and types of utilization review jobs, including:
- Utilization Review Nurse
- Utilization Review Coordinator
- Utilization Review Manager
- Utilization Review Analyst
- Utilization Review Consultant
Each of these roles may have slightly different responsibilities and requirements, but all involve reviewing medical records and treatment plans to ensure that they are appropriate and cost-effective.
Locations with the Most Popular Jobs in USA
According to data from the Bureau of Labor Statistics, the states with the highest employment levels for medical and health services managers, which includes utilization review specialists, are California, Texas, New York, Florida, and Pennsylvania. However, utilization review jobs can be found in healthcare organizations throughout the country.
What Are the Typical Tools
Utilization review specialists may use a variety of tools and technologies to perform their job duties, including:
- Electronic health records (EHRs)
- Medical coding software
- Data analysis tools
- Communication and collaboration software
- Project management tools
In addition, utilization review specialists may use spreadsheets, databases, and other tools to help analyze and manage healthcare data.
In Conclusion
Utilization review jobs are an important part of the healthcare industry, helping to ensure that patients receive the best possible care while also controlling costs. If you have strong analytical and critical thinking skills, excellent communication and interpersonal skills, and a desire to work in healthcare, a career in utilization review may be a great fit for you.