Utilization Review Specialist
Cooley Dickinson Hospital (CDH)

Northampton, Massachusetts

Posted in Health and Safety


Job Info


The Utilization Review Specialist is responsible for using clinical best practice knowledge and skilled intervention to determine patient level of care and provide concurrent review with insurance payers in order to achieve quality outcomes and ensure appropriate reimbursement.

This position reports to the Director, Case Management, Social Work and Pastoral Care and operates within established organizational and departmental policies and procedures.

Qualifications

  • Graduate of an approved, accredited school of nursing required
  • RN licensure in the Commonwealth of Massachusetts required; BSN required or must be enrolled in BSN program or actively in pursuit of BSN
  • Case Management certification preferred
  • One (1) to three (3) years experience in either hospital or payer-based case management, discharge planning, utilization management, and/or reimbursement required
  • Strong knowledge of disease processes and clinical documentation skills required
  • Demonstrated knowledge of InterQual criteria required
  • Demonstrated excellent interpersonal, organizational, and communication skills as well as the ability to collaborate effectively with physicians and other members of the healthcare team required
  • Demonstrated ability to orchestrate many activities and manage multiple priorities required
  • Demonstrated proficiency with personal computer required
  • Excellent vocabulary, grammar, spelling, punctuation, and composition skills proven through the development of written communication required


EEO Statement
It is the policy of Cooley Dickinson Health Care to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Cooley Dickinson Health Care will provide reasonable accommodations for qualified individuals with disabilities.

Cooley Dickinson Health Care embraces diverse skills, perspectives and ideas, and encourages people of color, veterans, people with disabilities, LGBTQ candidates, and people from other underrepresented groups to apply.



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