PHRN Utilization Reviewer (MDS) | Get a 21K Signing Bonus

Utilization Reviewer – ISTA Solutions

ISTA Solutions, an outsourcing/offshoring company, is searching for a Utilization Reviewer to join our rapidly expanding team. As a member, you will work with highly skilled professionals who prioritize employee satisfaction and work‑life balance.

Responsibilities

• Perform Utilization Management (UM) reviews in accordance with US State/Federal and other mandated regulations.
• Maintain compliance with regulatory changes affecting UM.
• Conduct UM reviews (Prospective/Concurrent/Retrospective) for inpatient services according to prescribed standards and client requirements.
• Review UM requests against established clinical review criteria, referring cases that do not meet criteria to a physician reviewer or prescribed escalation protocol.
• Coordinate physician reviewers or MDS/Facility–Nurse Practitioner as needed and follow up promptly to obtain and deliver results.
• T...