We, utilization review specialists, assess the patient care plans. We determine the suitable treatments for the patients. We ensure that treatments are cost-effective for the patients. We investigate the medical claims of the patients. We are responsible for coordinating the training for staff. Our duties include the analysis of medical records. As utilization review specialists, we inform the personnel about medical claims denial and approval. We review the medical claims. Some of us work as an advocate for patients’ care. We ensure that nurses and doctors are choosing suitable treatments. We are responsible for providing long-term treatment. Also, we ensure that patients receive the treatment as per their needs.
Core tasks:
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