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Clinical Utilization Review Specialist

1 month ago

Chicago, Illinois, United States R1 RCM Full time
Job Summary

R1 RCM is seeking a skilled Clinical Utilization Review Author to join our team. As a key member of our Physician Advisory team, you will play a critical role in providing first-level initial admission and continued stay case reviews for our hospital clients.

Key Responsibilities
  • Determine the appropriate cases for review, utilizing client-specific guidelines.
  • Ensure that appropriate orders and clinical documentation are in place prior to the application of evidence-based criteria.
  • Perform initial admission and continued stay reviews utilizing InterQual or Milliman to identify and support the appropriate level of care.
  • Abstract data from a variety of medical records to ensure accurate clinical data.
  • Adhere to established quality, timeliness, and productivity outputs required in the completion of first-level nursing utilization review.
Requirements
  • Active Registered Nurse license
  • Experience in a clinical inpatient environment and hospital-based utilization or case management experience
  • Proficiency in basic computer skills
About R1 RCM

R1 RCM is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We combine the deep expertise of a global workforce of revenue cycle professionals with the industry's most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.