Denials Management Specialist-UR
Department: Utilization Review
Shift: 1st Shift
It is the mission of Graham Health System to provide compassionate, quality health services, in a responsible and charitable manner, to the people and communities we serve. We are the community’s choice for an exceptional healthcare experience. Graham Health System is seeking a great applicant to join our team. Graham Health System offers a great team atmosphere with multiple benefits.
The Utilization Review (UR) Denials Management Specialist is responsible for all aspects of utilization review process (observation, admission, concurrent and retrospective) and ensures medical necessity of acute care hospitalization has supportive documentation in the electronic medical record, as well as appropriate utilization of resources. The UR Denial Management Specialist Acts as liaison between 3rd party payer case management and hospital case management to obtain the necessary clinical information to secure authorization of entire hospital stay. This person participates in the appeal process when deemed necessary by the Business Services Denials Management Specialist on cases where payment has been denied. This UR Denials Management Specialist reports directly to the Director of Utilization Review.
Must be graduate of accredited nursing program and be a currently licensed, registered or licensed practical nurse in the State of Illinois. Bachelor’s Degree in Nursing preferred. Minimum of two years healthcare experience required. Must have excellent human relations and oral/written communication skills. Acute care utilization management experience preferred.