Utilization Review Specialist

Marshfield Clinic; Marshfield (WI); On-site; USD 70,000 - 90,000; Full time

Job summary

Marshfield Clinic seeks a Utilization Review Specialist to provide quality assurance in the Revenue Cycle Administration. The ideal candidate will have an LPN license and significant clinical experience, ensuring optimal patient care and collaborating with medical staff. Join a team committed to accessible and compassionate healthcare.

Qualifications

• LPN license with the State Nursing Board required.
• Five years' experience in a clinical setting preferred.

Responsibilities

• Perform quality control related to patient treatment to ensure clinical roles are adequately provided.
• Support the comfort, health, and safety of patients.

Skills

Analyzing current environment

Knowledge of services for patient care

Effective communication skills

Understanding of HIPAA

Knowledge of quality management methods

Education

Graduate from an accredited practical nursing program as a Licensed Practical Nurse (LPN)

Registered Nurse (RN)

Job description

Come work at a place where innovation and teamwork come together to support the most exciting missions in the world!

Job Title: Utilization Review Specialist

Cost Center: 101651289 Revenue Cycle Administration

Scheduled Weekly Hours: 40

Employee Type: Regular

Work Shift: 40 Normal (United States of America)

Job Description:

JOB SUMMARY

The Utilization Review Specialist in Revenue Cycle provides quality assurance of medical care. Performs quality control related to patient treatment by medical staff to ensure clinical roles are adequately provided for patients' comfort, health, and safety.

JOB QUALIFICATIONS

EDUCATION

For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution recognized by the Council for Higher Education and Accreditation.

Minimum Required: Graduate from an accredited practical nursing program as a Licensed Practical Nurse (LPN).

Preferred/Optional: Registered Nurse (RN).

EXPERIENCE

Minimum Required: Five years' experience in a clinical setting. Preference given to individuals with experience in utilization or with CPT/ICD knowledge.

• Understanding of analyzing the current environment and synthesizing ideas for process improvement.
• Knowledge of medical, social, economic, and other services for integrating treatments for optimal patient care.
• Knowledge of factors contributing to quality patient care and ability to influence them positively.
• Knowledge of collaborative techniques to promote information sharing and teamwork.
• Effective communication skills to transmit and interpret ideas and information accurately.
• Understanding of HIPAA to ensure patient coverage and privacy.
• Knowledge of medical information tools to analyze and interpret clinical data.
• Knowledge of medical investigation policies and legal matters to assess treatment quality and accuracy.
• Knowledge of quality management methods to support organizational quality goals.

Preferred/Optional: None

CERTIFICATIONS/LICENSES

Minimum Required: Unencumbered LPN license with the State Nursing Board and/or multi-state licensure privileges.

Preferred/Optional: None

Marshfield Clinic Health System is committed to accessible, affordable, and compassionate healthcare. Successful applicants will prioritize listening, serving, and addressing patient and customer needs.

Exclusion from Federal Programs: Employee must not be excluded from federally funded programs like Medicare and Medicaid. Immediate notification is required if exclusion occurs.

Equal Opportunity Employer: Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration regardless of sex, gender identity, sexual orientation, race, color, religion, national origin, disability, veteran status, age, or other protected characteristics.