Clinical Utilization Review Specialist II

Prime Healthcare; Evanston (IL); On-site; USD 72,000 - 104,000; Full time

Benefits offered by this job

Paid time off

401K

Medical insurance

Dental insurance

Vision coverage

Tuition reimbursement

Job summary

Saint Francis Hospital in Evanston, IL seeks a full-time Utilization Management professional to coordinate clinical reviews and ensure admission criteria are met for inpatient and other care levels. You will collaborate with the Chief Medical Officer, participate in Case Management and UR meetings, and educate departments on guidelines and documentation requirements.

The role requires medical/dental/PA/nursing graduate qualifications, UR experience, knowledge of clinical pathophysiology, and

Qualifications

• Medical/Dental/PA/Nursing grad required with UR experience.
• Knowledge of clinical pathophysiology and pharmacology.
• Excellent communication and interpersonal skills.

Responsibilities

• Coordinate and complete clinical reviews for patient records.
• Participate in Case Management and UR meetings.
• Educate departments on guidelines and documentation requirements.
• Review charts to assess admission criteria for levels of care.
• Coordinate discharge referrals and respond to payer requests.

Skills

Acute care experience

Excellent communication

Interpersonal skills

Independent work

Typing 35 wpm

Education

Medical/Dental/PA/Nursing graduate

ECFMG Certification

Bachelor's in Health/Human Services

MPH or related health care degree

Tools

10-key data entry

CRM/records systems

Job description

Saint Francis Hospital in Evanston, IL seeks a full-time Utilization Management professional to coordinate clinical reviews and ensure admission criteria are met for inpatient and other care levels. You will collaborate with the Chief Medical Officer, participate in Case Management and UR meetings, and educate departments on guidelines and documentation requirements.

The role requires medical/dental/PA/nursing graduate qualifications, UR experience, knowledge of clinical pathophysiology, and