Utilization Review Specialist

Priority Dispatch Corp.; North Dakota; Hybrid; USD 29,000 - 36,000; Full time

Job summary

West River Health Services in Hettinger, ND seeks an experienced Utilization Review Specialist to monitor resource use, ensure medical necessity, and support payer authorizations. The role reports to the HIM Manager and focuses on chart reviews and coordination with discharge planning.

The position emphasizes accurate documentation, adherence to guidelines, and timely preauthorization processes in a rural hospital setting. Experience in clinical environments is required.

Qualifications

• LPN license or RHIT credential (coding certifications also acceptable: CCS, CCS-P, CPC, CPC-H)
• 3 years relevant experience; minimum 1 year healthcare/clinical experience

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 coordination

Medical necessity reviews

Payer authorization

Education

RHIT credential

LPN license

CCS/CCS-P/CPC/CPC-H

Job description

Utilization Review Specialist # Utilization Review SpecialistHettinger, ND 58639## OverviewSalary Range$21.35 - $26.33 HourlyLevelExperiencedPosition TypeFull TimeEducation LevelNot Specified## DescriptionWest 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 Summary**Under 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 placement## Qualifications**Required**- LPN license or RHIT credential (coding certifications also acceptable: CCS, CCS-P, CPC, CPC-H)- 3 years relevant experience; minimum 1 year healthcare/clinical experience*West River Health Services is an Equal Opportunity Employer.*