Utilization Review Specialist Job at West River Health Services, Hettinger, ND

amZYRVdBNWxJc2hYRWVKOE5XcGUzQjdnTVE9PQ==
  • West River Health Services
  • Hettinger, ND

Job Description

Position Summary:
Under the direct supervision of the HIM manager, the UR specialist monitors the utilization of resources, risk management and quality of care for patients in accordance to established guidelines and criteria for designated setting and status. Collection of clinical information necessary to initiate commercial payer authorization. Obtain and maintain appropriate documentation concerning services in accordance to reimbursement agency guidelines.

Excellence in Practice:
  • Performs preadmission review on admissions when required by insurance companies/agencies to comply with policies and procedures.
  • Works in coordination with discharge planner, monitoring medical necessity for admissions and appropriate level of services.
  • May also need to notify physician and patient of authorization denials.
  • Inputs collected data into computer system for insurance communication.
  • Assists with retrospective review of specified charts as required.
  • Obtains extensions in length of stays from insurance companies if needed.
  • Obtains preauthorization and/or precertification of services.
  • Reviews hospital records daily to determine if utilization resources could be served in a better environment, OBS vs INPT.
  • Ability to interact on an interpersonal basis with providers and other staff within the organization.
Essential Job Requirements:
  • Education : Appropriate education level required in according with licensure.
  • Experience : Three years of relevant experience with superior communication and interpersonal skills. Minimum one year healthcare or clinical experience required.
  • License Requirements : Licensed Practical Nurse (LPN) license with State Nursing Board and/or possess multistate licensure privileges or a Registered Health Information Technician (RHIT) required. Additional coding certifications also acceptable such as certified coding specialist (CCS), certified coding specialist physician (CCS-P), certified professional coder (CPC) and certified professional coder – hospital (CPC-H).

Job Tags

Full time,

Similar Jobs

Revel Staffing

Junior Network Engineer Job at Revel Staffing

 ...A confidential technology and infrastructure leader is seeking a Junior Network Engineer to support mission-critical network and security operations . This is a high-visibility position within a secure data environment , providing hands-on experience with firewalls... 

Metropolitan Transportation Authority

Transit Management Analyst Series Job at Metropolitan Transportation Authority

Transit Management Analyst Series Location New York, NY : Description Job Information: Title: Transit Management Analyst Series First Date of Posting: 3/18/25 Last Date of Filing: Until Filled Authority: New York City Transit Authority Department: Office of the President... 

SWA Group

Mid-Level Landscape Designer/Architect Job at SWA Group

 ...SWA Los Angeles Seeks Mid-Level Landscape Designer/Architect with Experience in Design, Project Management, and Construction Documents SWA is an award-winning, international landscape architecture, planning, and urban design firm with offices in California, Texas,... 

Uline

Business Operations Analyst Internship - Summer 2026 Job at Uline

 ...Business Operations Analyst Internship Paid Internship - Summer 2026 Corporate Headquarters 12575 Uline Drive, Pleasant Prairie, WI 53158 Boost your analytical skills and kick-start your career! As a 2026 Uline Business Operations Analyst Intern, you'll get hands... 

Johns Hopkins Medicine

ASSEMBLER Job at Johns Hopkins Medicine

 ...Position Summary: The Assembler assists in the food tray make-up area by starting, assembling...  ...per week Rotating Shift Weekend Work Required Location: Sibley Memorial...  ...Johns Hopkins Health System and its affiliates are drug-free workplace employers....