Utilization Reviewer

Baptist Health is the largest healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties.

To learn more about Baptist Health, visit us at https://www.baptistfirst.org.

Highlights:

Summary: The Utilization Reviewer shall coordinate care of an assigned caseload of patients through collaboration with physicians, nursing staff, and other health professionals to facilitate efficient utilization of clinical resources, optimal clinical and continuing care, as well as financial outcomes. This individual will provide concurrent and retrospective clinical review of medical records to evaluate the appropriate utilization of services, and facilitate optimal physician documentation. This position may have additional duties assigned that are within scope of the role. Education / Experience:Degree in Nursing with a BSN preferred or Bachelor's degree in Social Work required. Two years' hospital patient care experience preferred. Experience with Case Management or Utilization Review (third party payer reimbursement, DRGs) preferred. If LPC or SW, then three years hospital experience preferred. License / Certification: Active RN, LPC, or SW license required Knowledge, Skills, and Abilities:
• Must be familiar with the resource and payor criteria for adult and geriatric patients
• Must possess basic computer skills.
• Knowledgeable in use of appropriate infection control or isolation techniques when necessary.
• Strong oral, written and interpersonal skills.
• Ability to work independently with minimal supervision.
• Must be able to function in high-stress environment subject to frequent interruptions and changing priorities.

Working Conditions/Physical Requirements: Position requires sitting for 80% of the workday and mobility 20% of the workday.
There is occasional stooping, bending, kneeling, and crouching.
There is frequent reaching, use of hands and repetitive action.
Requires occasional lifting or carrying up to 25 pounds, pushing/pulling up to 150 pounds.
There is a continuous need for speaking with clear diction and hearing sensitivity in conversation either by phone or in person.
Continuous visual acuity at close and distant range.
Inside protected from weather conditions but not necessarily from temperature changes. Minimal noise levels.
Much exposure to computer work.
Occasional exposure to risk of electrical shock.
Some exposure to infectious disease while performing job-related tasks.
Some exposure to hazardous chemicals. Occasional exposure to radiation.

Primary Location:

Crossbridge Behavioral Health

Job:

Utilization Reviewer

Utilization Reviewer

Job Type:

Regular-Full time

Shift:

First Shift (United States of America)