Healthcare Utilization Specialist

1 week ago


Springfield, Illinois, United States Memorial Health University Medical Center Full time

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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