Utilization Review Specialist

West River Health Services is a mission-driven Critical Access Hospital and Rural Health Clinic serving the residents of southwestern North Dakota. Guided by our core values of Excellence, Innovation, Compassion, and Respect, we're committed to providing the kind of quality health care typically found in larger cities, delivered with small-town friendliness and individual care. We believe our employees are the foundation of that commitment, working together to deliver safe, high-quality, patient-centered care.

Job Summary

Under the direct supervision of the HIM Manager, monitors utilization of resources, risk management, and quality of care for patients per established guidelines, collecting clinical information for payer authorization.

Key Responsibilities

- Perform preadmission and retrospective chart reviews

- Coordinate with discharge planning on medical necessity and level of service

- Obtain preauthorization, precertification, and length-of-stay extensions

- Review hospital records daily for appropriate care environment placement

Required

- LPN license or RHIT credential (coding certifications also acceptable: CCS, CCS-P, CPC, CPC-H)

- 3 years relevant experience; minimum 1 year healthcare/clinical experience

West River Health Services is an Equal Opportunity Employer.