Medical Utilization Management Specialist - Radiology

Fairfax, Virginia
Jul 31, 2017
Sep 04, 2017
Full Time

Utilization Management Specialist - Radiology

The role of the specialist includes providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency of radiology services and procedures. The UMS will validate the documentation contained in the medical record, apply utilization review criteria, clinical knowledge/assessment and application of payer specific rules/guidance to determine appropriateness of radiology services ordered. Position requires collaboration with other healthcare providers to promote the most appropriate, and effective use of diagnostic imaging to ensure quality outcomes.

Essential Functions:

1) Determines and manages appropriate levels of radiology services; using clinical knowledge, established guidelines, and physician consultation. 
2) Conducts initial medical necessity clinical screening. Determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.
3) Notifies ordering physician, FRC facility staff and patients of the outcome of the review and options available.
4) Educates staff, patient and physicians on trends and changes in health plan medical coverage policies pertaining to services provided by FRC.

Basic Qualifications:

1) Three (3) to five (5) years of clinical experience in healthcare setting, preferably radiology.
2) Experience in utilization review, case management, discharge planning, and managed care.
3) Familiarity with managed health care programs including HMO, PPO, and POS be a plus.
4) Familiarity with ICD-10 and CPT 4 coding would be a plus.

Licenses, Certifications, Registrations:
Current Virginia license as a Registered Nurse, Radiology Technologist or other accredited clinical specialty preferred.

FRC offers competitive salary and excellent work environment.

To submit your resume and desired salary, please: 
1) press APPLY button OR 
2) submit to: 
3) or FAX to 703 698 4451.

For more information, or to apply now, you must go to the website below. Please DO NOT email your resume to us as we only accept applications through our website.

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