Healthcare Utilization Specialist
1 week ago
Job Summary:
Memoorial Health University Medical Center requires a Healthcare Utilization Specialist to evaluate patient records and facilitate communication with third-party payors.
About the Role:
This position involves analyzing patient records for medical necessity, ensuring accurate reimbursement, and collaborating with the patient care team to achieve optimal healthcare outcomes.
Main Responsibilities:
- Analyze patient records to determine medical necessity and support reimbursement for hospital admissions.
- Communicate with third-party payors to ensure accurate reimbursement.
- Collaborate with the patient care team to ensure awareness of general length of stay requirements.
- Foster effective physician documentation through concurrent interaction with physicians.
- Contribute clinical knowledge and data collection for quality improvement initiatives.
- Enhance reimbursement for acute care services.
Key Qualifications:
- Current RN licensure in the State of Illinois.
- Minimum 3-5 years of recent acute care and/or home health nursing or case management experience (previous utilization review experience strongly preferred).
Estimated Annual Compensation: $85,000
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