Utilization Review Specialist

Priority Dispatch Corp.; Hettinger (ND); On-site; USD 52,000 - 70,000; Full time

Job summary

West River Health Services is seeking a Hospital Information Management professional to monitor utilization, risk, and quality of care under the HIM Manager. The role involves chart reviews, discharge planning coordination, and ensuring medical necessity for services.

Required are 3+ years in HIM, with at least 1 year in healthcare settings. LPN license or RHIT credential is required to qualify.

Qualifications

• 3 years relevant experience in HIM/health information management.
• Minimum 1 year healthcare/clinical experience required.
• LPN or RHIT credential required.

Responsibilities

• Perform preadmission and retrospective chart reviews.
• Coordinate with discharge planning on medical necessity and level of service.
• Obtain preauthorization, precertification, and length-of-stay extensions.
• Review hospital records daily for appropriate care environment placement.

Skills

Preadmission reviews

Discharge planning

Preauthorization

Clinical documentation

Education

LPN license

RHIT credential

Job description

West River Health Services is a mission-driven Critical Access Hospital and Rural Health Clinic serving the residents of southwestern North Dakota. Guided by our core values of Excellence, Innovation, Compassion, and Respect, we're committed to providing the kind of quality health care typically found in larger cities, delivered with small-town friendliness and individual care. We believe our employees are the foundation of that commitment, working together to deliver safe, high-quality, patient-centered care.Job SummaryUnder the direct supervision of the HIM Manager, monitors utilization of resources, risk management, and quality of care for patients per established guidelines, collecting clinical information for payer authorization.Key Responsibilities- Perform preadmission and retrospective chart reviews- Coordinate with discharge planning on medical necessity and level of service- Obtain preauthorization, precertification, and length-of-stay extensions- Review hospital records daily for appropriate care environment placementRequired- LPN license or RHIT credential (coding certifications also acceptable: CCS, CCS-P, CPC, CPC-H)- 3 years relevant experience; minimum 1 year healthcare/clinical experienceWest River Health Services is an Equal Opportunity Employer.