Utilization Review Specialist

Job overview

The Utilization Review Specialist role is onsite in Miami, FL. Compensation is not specified. The position supports hospital utilization review and management, including reviews tied to payer requirements. The role evaluates patient records for medical necessity, appropriate levels of care, length of stay, and reimbursement compliance. It contributes to timely authorization, accurate reimbursement, and reduced claim denials through reviews and coordination with physicians, payers, and hospital teams.

What you'll do

• Review admissions, extended stays, and discharges for Medicare, Medicaid, insurance, and HMO patients
• monitor length of stay
• analyze care utilization data
• conduct retrospective reviews and medical care evaluation studies
• consult supervisors and physicians
• assist with reconsideration letters and diagnostic reviews
• participate in quality, safety, and infection-control studies.

What we're looking for

Skills & competencies

utilization review

hospital review

miami fl

westchester general hospital

medical necessity

length of stay

medicare

medicaid

payer coordination

reimbursement compliance

patient records

full-time

Work arrangement

• Weekend coverage required

About the employer

Westchester General Hospital is hiring for this role. Industry: General Medical and Surgical Hospitals. Sector: 62.