Utilization Review Specialist Job at West River Health Services, Hettinger, ND

UlJKTFRVdGZJT2VrY2dpRlU3L3dHTDh6S1E9PQ==
  • West River Health Services
  • Hettinger, ND

Job Description

Position Summary:
Under the direct supervision of the HIM manager, the UR specialist monitors the utilization of resources, risk management and quality of care for patients in accordance to established guidelines and criteria for designated setting and status. Collection of clinical information necessary to initiate commercial payer authorization. Obtain and maintain appropriate documentation concerning services in accordance to reimbursement agency guidelines.

Excellence in Practice:
  • Performs preadmission review on admissions when required by insurance companies/agencies to comply with policies and procedures.
  • Works in coordination with discharge planner, monitoring medical necessity for admissions and appropriate level of services.
  • May also need to notify physician and patient of authorization denials.
  • Inputs collected data into computer system for insurance communication.
  • Assists with retrospective review of specified charts as required.
  • Obtains extensions in length of stays from insurance companies if needed.
  • Obtains preauthorization and/or precertification of services.
  • Reviews hospital records daily to determine if utilization resources could be served in a better environment, OBS vs INPT.
  • Ability to interact on an interpersonal basis with providers and other staff within the organization.
Essential Job Requirements:
  • Education : Appropriate education level required in according with licensure.
  • Experience : Three years of relevant experience with superior communication and interpersonal skills. Minimum one year healthcare or clinical experience required.
  • License Requirements : Licensed Practical Nurse (LPN) license with State Nursing Board and/or possess multistate licensure privileges or a Registered Health Information Technician (RHIT) required. Additional coding certifications also acceptable such as certified coding specialist (CCS), certified coding specialist physician (CCS-P), certified professional coder (CPC) and certified professional coder – hospital (CPC-H).

Job Tags

Full time,

Similar Jobs

ProPivotal Staffing

Real Estate Property Accountant (Residential) Job at ProPivotal Staffing

 ...~ Associates degree in Accounting, Business Administration, or equivalent practical experience ~ Prior experience working with Yardi software Nice-to-Have Experience: Exposure to mixed-use or affordable housing accounting Experience preparing financial packages... 

Tapestry

Design Apprentice Job at Tapestry

Tapestry is seeking a Design Apprentice for its Ready-to-Wear division in New York. This entry-level position offers the opportunity to assist in the creation of fashion collections, conduct trend research, and collaborate with various teams. Ideal candidates will have... 

Department of Forestry & Fire Protection

Defensible Space Inspector Job at Department of Forestry & Fire Protection

Job Description and Duties See the attached Duty Statement for information about the position. Filling Limited Term for up to 24 months with the possibility of becoming permanent. For specific questions related to the duties of the position, contact Division Chief-...

Acara Solutions

Digital Marketing Coordinator Job at Acara Solutions

 ...The Digital Marketing Coordinator, provides support to the marketing team to optimize the organization's digital marketing programs with a focus on content creation and management. This role will oversee social media management platform HootSuite, engage customers via... 

Dynamics ATS

Warehouse Associate Job at Dynamics ATS

 ...Type of Employment Contract Employer Info Our client is a provider of electrical, industrial, communications, maintenance, repair and operating (MRO), and original equipment manufacturer (OEM) products, as well as construction materials and advanced supply...