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

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.

• 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.