Discharge & Utilization Review Specialist

TimeTrex (TimeTrex Software Inc.); Arcata (CA); On-site; USD 75,000 - 95,000; Full time

Job summary

Mad River Community Hospital in Arcata, California, seeks a Utilization Review Coordinator to oversee and evaluate utilization review activities within inpatient care settings. The role requires collaboration with health plans and providers to ensure proper resource use and effective discharge planning.

Candidates should hold a Bachelor or Master’s degree in a related field, possess current clinical licensure, and have experience in utilization or case management. Proficiency in electronic records and MS Office is essential.

Join a family-oriented workplace committed to exceptional patient care!

Qualifications

• Bachelor or Master’s degree in Nursing, Social Work, Sociology, or related field from an accredited school.
• Current clinical licensure, either Registered Nurse or Licensed Clinical Social Worker, preferred.
• Previous experience in utilization management, case management, discharge planning and/or home health or rehab preferred.
• Two to five years of recent acute care clinical experience.

Responsibilities

• Collaborates and coordinates with health plans and providers/care teams to ensure appropriate utilization of resources and timely discharge.
• Provides clinical review for different healthcare services requiring authorization.
• Communicates with insurance representatives and third party payers to ensure appropriate authorization for care.
• Develops comprehensive discharge/transitional care plans based on patient assessments.

Skills

Clinical review

Communication with insurance providers

Coordination with care teams

Experience with electronic medical records

MS Office proficiency

Education

Bachelor or Master’s degree in Nursing, Social Work, Sociology, or related field

Job description

Mad River Community Hospital in Arcata, California, seeks a Utilization Review Coordinator to oversee and evaluate utilization review activities within inpatient care settings. The role requires collaboration with health plans and providers to ensure proper resource use and effective discharge planning.

Candidates should hold a Bachelor or Master’s degree in a related field, possess current clinical licensure, and have experience in utilization or case management. Proficiency in electronic records and MS Office is essential.

Join a family-oriented workplace committed to exceptional patient care!