Medusind

Nurse

• Lead training for new onshore Representatives and oversee development of payer-specific training materials
• Conduct CDI and documentation standardization training across customers
• Partner with QA to perform ongoing utilization review audits and monitor accuracy trends
• Provide educational feedback to facilities on supporting documentation required for authorization approvals
• Support knowledge transfer to Training Leads and disseminate new payer/process updates
• Conduct administrative, concurrent utilization, and retrospective reviews via live, voicemail, fax, and portal reviews
• Coordinate peer reviews as needed
• Provide Assignment of Responsibility form templates at admission when required
• Enter utilization review authorization information into facility EMR billing systems and internal workflow systems
• Follow up on pending authorizations to secure approvals and documentation
• Document and track utilization review activities in Salesforce and designated systems
• Assist with document retrieval from EMRs
• Act as liaison between facilities and internal teams
• Send morning and end-of-day facility status updates and weekly stakeholder summaries
• Maintain understanding of levels of care, insurance authorization requirements, and behavioral health regulations
• Identify documentation gaps affecting authorization approvals
• Review clinical documentation from a licensed nursing perspective and communicate charting deficiencies to facilities
• Serve as clinical resource for escalations and complex case reviews
• Ensure authorization requests comply with policies and payer requirements
• Perform additional utilization review and prior authorization duties as assigned

Utilization Review Specialist – LPN Required