Senior Clinical Utilization Review Specialist

mhnetwork; Huntington (WV); On-site; USD 60,000 - 90,000; Full time

Job summary

mhnetwork is seeking a Utilization Review Specialist to collaborate with physicians and ensure appropriate level of care using clinical guidelines, with a focus on reducing unnecessary stays and costs. The role requires a clinical background, WV RN license, and CM certification within 2 years of hire.

Expect a high level of communication and problem-solving with the healthcare team. The shift will be determined by each hiring manager; pay rate is set according to the labor agreement.

Qualifications

• Bachelor's degree with a clinical background required.
• WV RN License Required.
• Certification - Case Management within 2 year post hire.
• 5+ years experience in patient care in hospital setting, care management, discharge planning and resource management.
• Clinical and leadership skills, DRG’s, analytical skills.

Responsibilities

Skills

Clinical background

Communication

Critical thinking

Education

Bachelor's degree in clinical field

WV RN License

Case Management Certification (within 2 years)

Job description

mhnetwork is seeking a Utilization Review Specialist to collaborate with physicians and ensure appropriate level of care using clinical guidelines, with a focus on reducing unnecessary stays and costs. The role requires a clinical background, WV RN license, and CM certification within 2 years of hire.

Expect a high level of communication and problem-solving with the healthcare team. The shift will be determined by each hiring manager; pay rate is set according to the labor agreement.