Utilization Review Specialist - Care Management (Casual) - 8033

About the role

The Utilization Review Specialist (URS) at St. Mary's Medical Center will work within the Care Management Department. This position requires the URS to exercise independent judgment and professional discretion in case management, collaborating with physicians to ensure patients receive appropriate levels of care using clinical guidelines like InterQual/MCG. The URS will also monitor patient stays to optimize care solutions that meet both patient and physician needs while adhering to payer contractual guidelines.

Responsibilities

• Collaborate with physicians to ensure patients receive appropriate levels of care using clinical guidelines like InterQual/MCG
• Maintain oversight of patient stays to optimize care solutions that meet both patient and physician needs
• Ensure compliance with payer contractual guidelines

Requirements

• Bachelor’s degree in healthcare, medical billing, or related field
• Minimum 2 years of experience in utilization review or similar healthcare field
• Knowledge of clinical guidelines such as InterQual/MCG
• Strong communication and collaboration skills

Qualifications

• Current certification in Utilization Review preferred
• Proficiency in electronic health records (EHR) systems

Skills

• Strong analytical and problem-solving skills
• Excellent interpersonal and communication skills
• Ability to work independently and as part of a team

Benefits

• Paid time off
• Health insurance coverage
• Flexible schedule options

Pay

Competitive salary commensurate with experience

Schedule

Full-time position with flexible scheduling options