Utilization Review Specialist- Interim- On-Site
American Consultants is looking for an interim Utilization Review Specialist for a critical access hospital in North Dakota. This is a temporary position.
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.
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).
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