Community Health Systems, Inc. is one of the nation’s leading operators of general acute care hospitals. The organization’s affiliates own, operate or lease 89 hospitals in 16 states with approximately 15,000 licensed beds. Affiliated hospitals are dedicated to providing quality healthcare for local residents and contribute to the economic development of their communities. Based on the unique needs of each community served, these hospitals offer a wide range of diagnostic, medical and surgical services in inpatient and outpatient settings.
Summary:
Utilization management is the analysis of the necessity, appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for admission to the hospital as well as continued stay. This function ensures that services are not only appropriate, but ensures that an authorization for services is obtained from payer, if required, and that documentation supports the care delivered in such a way that minimizes the risk of denials after discharge.
Essential Duties:
Qualifications:
Required Education: Associates Degree in Nursing
Preferred Education: Bachelors Science Nursing or higher
Required Experience: At least 3 years previous nursing experience
Preferred Experience: 3 plus years Utilization review experience
Required License/Registration/Certification: Licensed Practical Nurse or Licensed Registered Nurse
Preferred License/Registration/Certification: ACM or CCM Certification
Computer Skills Required: Data entry skills; Demonstrable skills with Google Docs, Google Sheets, and email applications.
Physical Demands:
In order to successfully perform this job, with or without a reasonable accommodation, the following are outlined below:
1. The Employee is required to read, review, prepare and analyze written data and figures, using a PC or similar, and should possess visual acuity.
2. The Employee may be require to occasionally climb, push, stand, walk, reach, grasp, kneel, stoop, and/or perform repetitive motions.
3. The Employee is not substantially exposed to adverse environmental conditions and; therefore, job functions are typically performed under conditions such as those found within general office or administrative work. May be exposed to biohazardous material and pathogens.
Minimum of 3-5 years medical office experience. Current knowledge of payer requirements for referrals and preauthorization.
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