Utilization Review Specialist

Marshall Health Network • Huntington, WV

1d • Onsite

About The Position

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.

Requirements

• 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.

Responsibilities

• Exercises independent judgment and professional discretion in the practice of case management to a select group of patients.
• Collaborates with physicians to ensure that patients are at the appropriate level of care with use of clinical based guidelines such as InterQual.
• Monitors continuing stay to protect patients against unnecessary quality and financial risk.
• Uses collaborative problem solving skills to meet the needs of the patients and physician while meeting the contractual guidelines of our payers.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level