Clinical Utilization Review Specialist

Olympia Fields Hospital; Olympia Fields (IL); On-site; USD 44,000 - 64,000; Full time

Job summary

Olympia Fields Hospital is seeking a full-time Utilization Review professional on-site in Olympia Fields, IL. You will coordinate clinical reviews, collaborate with the CMO, and participate in UR meetings to ensure appropriate admission and continuation of care.

You will gather data, respond to payer requests, coordinate discharge referrals, and uphold guidelines across inpatient and lower levels of care, with strong independent judgment and communication skills.

Qualifications

• Master of Public Health (MPH) or related health care field is required.
• Medical Graduate or Dental Graduate is required.
• Knowledge of Clinical Pathophysiology and Pharmacology is required.
• Excellent written and verbal communication skills.
• Excellent critical thinking and interpersonal skills.
• Ability to work independently in a time-oriented environment.
• Experience in Utilization Review/Case Management is highly preferred.
• 1+ year of clinical experience in acute care setting preferred.

Responsibilities

• Coordinates and completes clinical reviews for patient records with the CMO.
• Participates in Case Management and UR meetings.
• Educates departments on UR processes.
• Reviews charts to assess admission and continuation criteria.
• Gathers data and responds to payer/intermediary requests.
• Coordinates discharge referrals as requested by clinical staff and others.
• Works independently with sound judgment.
• Knowledge of federal, state, and intermediary guidelines for inpatient, acute care and lower levels of care.

Skills

Excellent written and verbal comms

Excellent critical thinking

Interpersonal skills

Ability to work independently

Typing speed 35 wpm

Education

Master of Public Health (MPH) or related health care field

Medical Graduate or Dental Graduate

Knowledge of Clinical Pathophysiology and Pharmacology

Tools

10-key data entry

Job description

Olympia Fields Hospital is seeking a full-time Utilization Review professional on-site in Olympia Fields, IL. You will coordinate clinical reviews, collaborate with the CMO, and participate in UR meetings to ensure appropriate admission and continuation of care.

You will gather data, respond to payer requests, coordinate discharge referrals, and uphold guidelines across inpatient and lower levels of care, with strong independent judgment and communication skills.