JOB SUMMARY
The Utilization Review Specialist, Revenue Cycle 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.
JOB QUALIFICATIONS
EDUCATION
For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.
Minimum Required: Graduate from an accredited practical nursing program as a Licensed Practical
Nurse (LPN).
Preferred/Optional: Registered Nurse (RN).
EXPERIENCE
Minimum Required: Five years' experience in a clinical setting required. Preference given to
individuals with experience in utilization or with CPT/ICD knowledge.
Understanding of the value of accurately analyzing the current environment andability to synthesize ideas and information required for process improvement into a manageable form.
Knowledge of the medical, social, economic, and other services provided by other departments or facilities, and the ability to integrate these multidisciplinary treatments for optimal patient care.Knowledge of the factors contributing to quality patient care, and the ability to influence these factors in a positive way.Knowledge of collaborative techniques and ability to promote a culture of information sharing and working together to solve business problems and meet business goals.Understanding of effective communication concepts, tools and techniques; ability to effectively transmit, receive, and accurately interpret ideas, information, and needs through the application of appropriate communication behaviors.Knowledge of main purpose and content of the Health Insurance Portability and Accountability Act (HIPAA); ability to ensure patient health care coverage and protect private information.Knowledge of medical information tools and techniques; ability to utilize these to organize, analyze and interpret clinical data to solve specific problems.Knowledge of tools, approaches, policies, and legal matters of medical services investigation, and ability to investigate the quality and accuracy of various medical treatments and interventions.Knowledge of quality management methods, tools, and techniques and ability to create and support an environment that meets the quality goals of the organization.Preferred/Optional: None
CERTIFICATIONS/LICENSES
The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.
Minimum Required: Currently holds an unencumbered Licensed Practical Nurse (LPN) license with
State Nursing board and/or possess multi-state licensure privileges.
Preferred/Optional: None
Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.
Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.