I have extensive experience in utilization review, having worked in a managed care setting for over five years. My role involved reviewing medical records, assessing the medical necessity of treatments, and ensuring compliance with insurance guidelines. I am proficient in using various review tools and software, which has enabled me to efficiently manage and process a high volume of cases.

I prioritize tasks by first identifying the urgency and impact of each task. I then create a structured plan that allocates time efficiently, ensuring critical tasks are addressed promptly. Regular check-ins and updates help me stay on track and adapt to any changes. This approach ensures that all tasks are completed without compromising quality or efficiency.

Maintaining accuracy involves a combination of careful review and systematic checks. I always double-check my work and cross-reference with guidelines and standards. Additionally, I take regular breaks to maintain focus and avoid fatigue, which helps in sustaining attention to detail throughout the day.

I approach disagreements with a collaborative mindset, aiming to understand the provider's perspective and explain the rationale behind the review decision. Open communication and providing clear, evidence-based justifications help in resolving conflicts amicably. I believe in building a respectful and professional relationship with healthcare providers to facilitate smoother reviews.

In a previous role, I encountered a case involving a patient with multiple chronic conditions, where the proposed treatment plan was costly and not clearly aligned with guidelines. I conducted a thorough review, consulted with specialists, and proposed an alternative plan that was both cost-effective and clinically appropriate. This approach not only resolved the case but also improved patient outcomes and reduced costs.