Utilization Review Specialist - Care Management (Casual) - 8033

About the role

The Utilization Review Specialist (URS) will collaborate with physicians to ensure patients are at the appropriate level of care using clinical guidelines like InterQual/MCG. The URS will monitor continuing stays to solve issues that meet patient and physician needs while adhering to payer contractual guidelines.

Responsibilities

• Collaborate with physicians to ensure patients are at the appropriate level of care using clinical guidelines like InterQual/MCG
• Maintain accurate documentation and reports related to utilization review activities
• Monitor continuing stays to identify and resolve issues that impact patient care and physician workflow
• Ensure compliance with payer contractual guidelines and regulatory requirements
• Participate in ongoing education and training to stay current with healthcare trends and reimbursement policies

Requirements

• Bachelor’s degree in Healthcare Administration, Nursing, or a related field
• Minimum 2 years of experience in healthcare utilization review or related field
• Knowledge of healthcare reimbursement models and regulations
• Strong analytical and problem-solving skills
• Excellent communication and interpersonal skills
• Proficiency in Microsoft Office Suite

Qualifications

• Current certification as a Utilization Review Specialist (URS)
• Experience working in an acute care setting preferred

Skills

• Strong attention to detail
• Ability to work independently and as part of a team
• Effective time management and organizational skills
• Strong computer skills, including proficiency in Microsoft Office Suite

Benefits

• Comprehensive health insurance coverage
• Paid time off and holidays
• Flexible scheduling options
• Professional development opportunities

Pay

$XX.XX - $XXXX per hour, depending on experience

Schedule

Full-time position, Monday through Friday, with some evening and weekend availability as needed