Utilization Review Specialist

Marshall Health Network • Huntington, WV

7d

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.

The shift will be determined by each hiring manager. The pay rate will be
determined in accordance with the labor agreement.

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

• 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