United States Job Openings
Sanford Health
Utilization Review Specialist - Behavioral Health
Thief River Falls
September 5, 2024
Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
Facility: Thief River Falls Downtown Campus
Location: Thief River Falls, MN
Address: 120 Labree Ave S, Thief River Falls, MN 56701, USA
Shift: Day
Job Schedule: Flex
Weekly Hours: 32.00
Salary Range: $26.00 - $41.50
Department Details
Come join our Behavioral Health team as a Utilization Review Specialist utilizing a team-based approach to patient care in a fun and supportive work environment.
Our work environment embraces diversity, has creative problem solving, and will help you grow as a person in the nursing field.
Job Summary
Provide quality assurance of medical care. Perform quality control related to patient treatment by medical staff to ensure clinical roles provided adequately for patients' comfort, health and safety. Identify quality issues through analysis of data and evaluation of clinical or business processes. Responsible for reviewing medical records and preparing clinical appeals, as appropriate, on medical necessity, level of care, length of stay, and authorization denials for hospitalized patients. Understand and provide insight into evaluating current process improvement strategies including quality, methods, and ability to maintain focus on the continuous improvement of processes, products and services. Provide feedback and education to other departments for denial prevention. Provide clinical insight into issues preventing insurance billing from occurring.
Serve as an advocate for patients and families needing an explanation of their charges and/or price estimates prior to procedures. Work as a liaison with third party auditors in scheduling and conducting audits for the enterprise. Verify patient charges to medical record if needed. Maintain a working knowledge of accounts receivable as well as remain current regarding federal and state regulations governing the verification of charges. Must remain competent in nursing practices with in-depth understanding of an array of illnesses, intensity of service, and care coordination needs in order to integrate clinical knowledge with billing knowledge.
Serve as the expert for Patient Financial Services for denials related to medical necessity of care. Cultivate positive working relationships with all internal and external contacts. Collaborate with multiple departments to improve process. Must understand and demonstrate leadership capability, handling conflict as it arises, and negotiate effectively. Serve as an expert resource and role model. Must be able to organize and prioritize tasks effectively.
Qualifications
Graduate from an accredited practical nursing program as a Licensed Practical Nurse (LPN). Registered Nurse (RN) preferred.
Five years' experience in a clinical setting required. Preference given to individuals with experience in utilization or with CPT/ICD knowledge.
Currently holds an unencumbered Licensed Practical Nurse (LPN) license with State Nursing board and/or possess multi-state licensure privileges.
Benefits
Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits .
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .
Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Req Number: R-0198401
Job Function: Revenue Cycle
Featured: No
New Job Alerts
Marriott International, Inc
Massage Therapist
Chicago
PART TIME
September 23, 2024
View Job DescriptionMarriott International, Inc
Guest Service Support Expert
San Diego
FULL TIME
September 23, 2024
View Job DescriptionAIS Insurance Specialists
Insurance Inside Sales Professional
FULL TIME
September 23, 2024
View Job DescriptionIdaho National Laboratory
Environmental Monitoring Generalist
FULL TIME
September 23, 2024
View Job DescriptionChick-fil-A Branson
Full Time Back of House Team Member
Branson
FULL TIME & PART TIME
September 23, 2024
View Job DescriptionUnited Wholesale Mortgage
Associate Talent Acquisition Specialist
Pontiac
FULL TIME
September 23, 2024
View Job DescriptionLooking for similar job?
Fremont Hospital
Utilization Management RN - Per Diem
Fremont
PART TIME
September 6, 2024
View Job DescriptionUniversity of California, Irvine
Case Manager EX- Utilization Management- FT Day Shift
Orange
FULL TIME
September 14, 2024
View Job DescriptionQuva Pharma
Quality Record Review Specialist- 2nd Shift
Bloomsbury
FULL TIME
August 26, 2024
View Job DescriptionState of Wisconsin
Environmental Analysis and Review Specialist - Project Position
Superior
FULL TIME
August 28, 2024
View Job DescriptionPrime Express LLC - Veteran Owned
PRMX Amazon Driver-$22.50+hr/$50K+yr/Paid every Friday!/BEST REVIEWS!
Tacoma
FULL TIME
August 23, 2024
View Job DescriptionProfessional Services Network, Inc
Clinical Data Abstractor/Reviewer ONCOLOGY RN – Remote Temporary Position
FULL TIME & PART TIME & CONTRACT
August 15, 2024
View Job DescriptionSee What’s New: Sanford Health Job Opportunities
Sanford Health
Clinical Athletic Trainer - Orthopedics & Sports Medicine Clinic - Full Time
Fargo
FULL TIME
September 22, 2024
View Job DescriptionSanford Health
Travel Dialysis Technician - FT Days
Bemidji
FULL TIME
September 22, 2024
View Job DescriptionSanford Health
Security Officer- Wed-Sat 7:00pm - 5:30am
Bemidji
FULL TIME
September 22, 2024
View Job DescriptionSanford Health
Associate Behavioral Health Counselor - EmPATH
Bemidji
FULL TIME
September 22, 2024
View Job DescriptionNew Job Alerts
Marriott International, Inc
Massage Therapist
Chicago
PART TIME
September 23, 2024
View Job DescriptionMarriott International, Inc
Guest Service Support Expert
San Diego
FULL TIME
September 23, 2024
View Job DescriptionAIS Insurance Specialists
Insurance Inside Sales Professional
FULL TIME
September 23, 2024
View Job DescriptionIdaho National Laboratory
Environmental Monitoring Generalist
FULL TIME
September 23, 2024
View Job DescriptionChick-fil-A Branson
Full Time Back of House Team Member
Branson
FULL TIME & PART TIME
September 23, 2024
View Job DescriptionUnited Wholesale Mortgage
Associate Talent Acquisition Specialist
Pontiac
FULL TIME
September 23, 2024
View Job Description