RN Inpatient Utilization Specialist

Group Health Cooperative of Eau Claire

Altoona (WI)

On-site

USD 70,000 - 90,000

Full time

3 days ago

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Benefits offered by this job

Wellness walks

Health & Fitness challenges

On-site fitness classes

Sit/Stand stations

And more!

Job summary

Group Health Cooperative of Eau Claire in Altoona, WI is seeking an Inpatient Utilization Management Specialist (RN) to assess, plan, and conduct utilization reviews and discharge planning to optimize member health outcomes. The role requires collaboration with an interdisciplinary team, documentation of determinations, and adherence to policy, HIPAA, and state and accreditation requirements.

This full-time position offers a comprehensive benefits package, vacation, retirement plan, health and

Qualifications

Must have customer service skills and strong communication abilities.
Professionals must demonstrate attention to detail and the ability to work under pressure.
Ability to collaborate with diverse teams and adapt to changing priorities.

Responsibilities

Processes prior authorization and pre-certification requests using tools and resources to determine medical necessity and benefit coverage.
Displays initiative in problem-solving, prioritizing tasks, and managing workload.
Consults with Market Leader, CMO, as necessary and implements changes.
Plans and implements strategies to reduce length of stay and ensure medically necessary admissions.