Utilization Review SpecialistWest River Health Services • Hettinger, North Dakota, United States
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Utilization Review Specialist
West River Health Services
- Hettinger, North Dakota, United States
- Hettinger, North Dakota, United States
About
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 accordance 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).
Languages
- English
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