Utilization Review Specialist

Cabell Huntington Hospital; Huntington (WV); On-site; USD 65,000 - 95,000; Full time

Job summary

The Utilization Review Specialist (URS) at Cabell Huntington Hospital exercises independent judgment in case management to ensure appropriate level of care using clinical guidelines such as InterQual. The URS collaborates with physicians to monitor continuing stay and to protect patients from unnecessary risk and cost.

The position requires a Bachelor’s degree with clinical background, WV RN license, and Case Management certification within 2 years of hire, with 5+ years of hospital patient care

Qualifications

• Bachelor's degree with a clinical background is required.
• West Virginia RN license is required.
• Certification in Case Management within 2 years post hire is required.
• Minimum 5+ years of hospital patient care experience and care management knowledge.

Skills

Verbal communication

Written communication

Collaboration

Critical thinking

Discharge planning

Resource management

Education

Bachelor's degree with a clinical background

WV RN License

Certification - Case Management within 2 year post hire

Job description

Job Desciption

The Utilization Review Specialist (URS) exercises independent judgment and professional discretion in the practice of case management to a select group of patients. The URS collaborates with physicians to ensure that patients are at the appropriate level of care with use of clinical based guidelines such as InterQual. The URS monitors continuing stay to protect patients against unnecessary quality and financial risk. The URS is proactive and uses collaborative problem solving skills to meet the needs of the patients and physician while meeting the contractual guidelines of our payers.

The shift will be determined by each hiring manager. The pay rate will be determined in accordance with the labor agreement.

Requirements

• Bachelor's degree with a clinical background required
• WV RN License Required
• Certification - Case Management within 2 year post hire
• 5 plus years experience - minimum experience includes patient care in the hospital setting, direct knowledge of care management, discharge planning and resource management. Clinical expertise in area of responsibility and management of patients in that area: Utilization management principles; excellent verbal and written communication skills; Builds effective relationships with the healthcare team; demonstrates critical thinking skills; Clinical and leadership skills, performance improvement, DRG’s, analytical skills.

Frequent prolonged sitting, walking and standing, carrying 25-30 pounds with books and computer, visual acuity for computer use, hearing acuity for phone use; Reaching and stretching.

This Company is an Equal Opportunity Employer, and does not discriminate on the basis of race, gender, ethnicity, religion, national origin, age, disability, veteran status, or on any other basis prohibited by law. Information on race, gender and national origin will only be used for statistical and recordkeeping purposes, and will not be used in making any employment decisions. All information provided will be kept separate from your expression of interest. Providing this information is strictly voluntary, and you will not be subjected to any adverse action or treatment if you choose not to provide this information. If you do not choose to answer these questions, we ask that you select "Decline to Identify" for each question. Thank you for your voluntary cooperation.