Utilization Review Specialist

📁
Professional Non-Clinical
📅
2019-R0223111 Requisition #
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POSITION SUMMARY:

Responsible for ensuring appropriate communication with third party payers to authorize hospital days. The Utilization Review Specialist obtains information from clinical reviews done by the case manager as well as patient medical information from other computer applications utilized by the facility.

 

POSITION RESPONSIBILITIES:

1. Utilizes case management software (Midas) to generate work lists

   

  2. Initiates authorizations for all admissions

   

  3. Submits clinical information per third party payer requirements

   

  4. Initiates precertification process for inpatient rehabilitation

   

  5. Upon identification of possible concurrent denial, the tech forwards the information to the appropriate case manager

   

  6. Notifies third party payer of patient discharge and secures all days

   

  7. Utilizes effective communication skills to Accurately complete work

   

  8. Collaborates effectively with all department staff to achieve goals and objectives

 

MINIMUM QUALIFICATIONS:

Education: High School Diploma/GED Required

Experience: None Required

Skills and Abilities: Medical Terminology and Computer Proficient (MS Word, Excel, and Outlook) preferred

 

 


About Us


Chances are, you’re here because you’re looking for a career offering greater opportunity, challenge and fulfillment. We’re confident you’ll find all three at CHI. As one of the nation’s largest nonprofit health systems, we offer a wealth of careers across more than 101 hospitals in 18 states. Our faith-based health system welcomes you to share in our mission of building healthier communities, whether as a surgeon in the operating room or an administrator in a conference room. When you work in a supportive environment with like-minded professionals, wonderful things happen. Learn More

Equal Opportunity Employment


Consistent with our Core Values, Catholic Health Initiatives employers are EEO/AA/M/F/Vets/Disabled Employers. Qualified applications will receive consideration for employement without regard to their race, color, religion, national origin, sex, sexual orientation, gender identification, protected veteran status, disabilitiy or any other legally protected characteristic. 

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