FULL_TIME

FEED

YEAR

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). 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.

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:<ul><li>Performs preadmission review on admissions when required by insurance companies/agencies to comply with policies and procedures.</li><li>Works in coordination with discharge planner, monitoring medical necessity for admissions and appropriate level of services.</li><li>May also need to notify physician and patient of authorization denials.</li><li>Inputs collected data into computer system for insurance communication.</li><li>Assists with retrospective review of specified charts as required.</li><li>Obtains extensions in length of stays from insurance companies if needed.</li><li>Obtains preauthorization and/or precertification of services.</li><li>Reviews hospital records daily to determine if utilization resources could be served in a better environment, OBS vs INPT.</li><li>Ability to interact on an interpersonal basis with providers and other staff within the organization.</li></ul>Essential Job Requirements:<ul><li>Education: Appropriate education level required in accordance with licensure.</li><li>Experience: Three years of relevant experience with superior communication and interpersonal skills. Minimum one year healthcare or clinical experience required.</li><li>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).</li></ul>Powered by JazzHR

West River Health Services

Utilization Review Specialist

Certified Coding Specialist (CCS)

Certified Professional Coder (CPC)

Clinical Data Collection

Clinical Medicine

Communication Systems

Computer Systems

Data Collection

Data Entry

Documentation

Healthcare

Hospital

Insurance

Interpersonal Skills

Licensed Practical Nurse/Licensed Vocational Nurse

Nursing Credentials

Patient Care

Patient Care Denials

Quality of Care

Registered Health Information Technician (RHIT)

Reimbursement Guidelines

Resource Utilization

Risk Management

Utilization Management

partner JazzHR

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Utilization Review SpecialistWest River Health Services

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