Clinical Utilization Specialist

6 days ago


Duluth, Georgia, United States Emory Healthcare Full time
Job Overview

We are seeking a skilled Clinical Utilization Specialist to join our team at Emory Healthcare. This role involves proactive patient outreach and care coordination to achieve optimal outcomes and wellness while decreasing preventable ED, inpatient, and readmission visits.

Responsibilities:
  • Conduct medical necessity reviews by utilizing Millman and Interqual Guidelines in conjunction with a review of the patient chart, clinical nursing judgement, and discussions with the attending physician and/or physician advisor.
  • Perform utilization review by completing a timely and comprehensive review of all new observation and inpatient admissions for status designation as guided by criteria guidelines, patient presentation, and clinical nursing judgement.
  • Communicate effectively with physicians and interdisciplinary teams regarding criteria guidelines and status designation on an individual patient basis.
About Us

Emory Healthcare is part of Emory University and is the most comprehensive academic health system in Georgia. We have 11 hospitals, including four Magnet designated facilities, and more than 425 provider locations. Our team is dedicated to providing equal opportunities and access to all individuals regardless of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression, and/or veteran's status.



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