Medical Care Specialist

3 days ago


La Crosse, Wisconsin, United States GUNDERSEN LUTHERAN ADMINISTRATIVE Full time
Job Summary:

As a Utilization Management Specialist at Gundersen Health System, you will play a vital role in evaluating medical records to ensure that patient hospitalizations and services are reasonable and necessary. This position requires a strong understanding of nationally recognized criteria and the ability to communicate effectively with healthcare teams.

Key Responsibilities:

• Perform medical necessity reviews of initial patient placement and continued stay reviews for hospitalizations
• Apply nationally recognized criteria during review of patients' medical records
• Provide communication on review determinations to attending physicians and external review organizations as required
• Collaborate with healthcare teams to ensure patient needs and discharge plans are documented and certified as medically necessary

Requirements:

• Minimum of Associate Degree in Nursing
• Minimum of 2 years RN experience
• RN licensure to practice in the state of Wisconsin upon hire

What We Offer:

• Support to grow in your career with access to our Career Development Center and Tuition Investment Program
• Top-rated retirement plan and healthcare benefits

About Us:

Gundersen Health System is healthcare for neighbors, by neighbors. We deliver world-class medical care combined with the right amount of love. We call it Love + Medicine and it's who we are.
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