Clinical Utilization Analyst

1 week ago


Columbia, Missouri, United States Lexington Medical Center Full time

Department: Utilization Management
Schedule: PRN
Shift: Rotating
Hours: Variable

About Lexington Medical Center: Consistently recognized as a leading healthcare provider, Lexington Medical Center is dedicated to delivering high-quality medical services tailored to the needs of the community. It is ranked #1 in the Columbia metro area by U.S. News & World Report and is proud to be named one of the Best Places to Work in South Carolina.

As a 607-bed teaching hospital, we anchor a comprehensive healthcare network that includes six community medical centers and employs over 8,700 healthcare professionals. Our network features a distinguished cardiovascular program, an accredited Cancer Center of Excellence, and a variety of specialized facilities, including an occupational health center and an Alzheimer's care center.

Position Overview: The role involves conducting medical record reviews for admissions and ongoing stays to assess the appropriateness of care. The specialist collaborates with attending physicians and healthcare teams throughout the patient's hospitalization, ensuring effective communication with third-party payors to secure necessary authorizations. This position plays a crucial role in optimizing patient throughput and managing length of stay while assisting with denial management.

Qualifications:

  • Education: ADN, Diploma Nursing Degree, or Bachelor of Science in Nursing
  • Experience: Minimum of 3 years in an acute care hospital environment
  • Licensure: Current Registered Nurse license in South Carolina

Key Responsibilities:

  • Engage in cooperative interactions that foster positive relationships among staff, patients, and families.
  • Demonstrate commitment to the organization by promoting a positive image of Lexington Medical Center.
  • Contribute to a collaborative work environment, ensuring effective teamwork.
  • Maintain confidentiality and handle sensitive information with discretion.
  • Perform thorough reviews of medical records to ensure compliance with regulatory standards and billing integrity.
  • Communicate effectively with various stakeholders, including physicians and third-party payors, regarding patient care and reimbursement issues.
  • Participate in discharge planning and identify opportunities for process improvements.

Benefits: We offer a comprehensive benefits package, including:

  • Day one medical, dental, and life insurance coverage
  • Flexible spending accounts for healthcare and dependent care
  • 403(b) retirement plan with employer matching
  • Employer-paid life insurance
  • Tuition reimbursement and student loan forgiveness programs

Equal Opportunity Employer: Lexington Medical Center is committed to providing equal employment opportunities to all individuals, ensuring a discrimination-free workplace.



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