Utilization Management Specialist

Utilization Review Specialist Apply Overview Salary Range $22.50 - $33.04 Hourly Job Shift Day Education Level 2 Year Degree Apply Description Who You’ll Join At  Santiam Hospital & Clinics , we believe exceptional patient care starts with a supportive and inclusive work environment. We empower every team member by providing access to advanced medical technology and continuous professional development. Join our collaborative culture, where your contributions are valued and your growth is encouraged. Come join our Utilization Management team as our new Utilization Management Specialist where you will play a critical role in ensuring patients receive the right care at the right time. Using clinical expertise and strong payer collaboration, this role drives timely authorizations, supports medical necessity decisions, and ensures compliance with CMS and payer guidelines. It’s an ideal opportunity for detail driven professionals who want to influence quality outcomes and support providers, while making a meaningful impact across the continuum of care. Take the next step in your healthcare career—apply today and bring your expertise to  Santiam Hospital & Clinics , recently honored as 2025’s Best Hospital in the Willamette Valley ! Position Schedule: Monday – Friday, 8:00 am – 12:00 pm Salary range: $22.50 - $33.04 What You’ll Do: Performs clinical chart reviews for appropriate admissions, continued stays, and supportive services to promote quality care and full and accurate capture of revenue. Ensure compliance with CMS, state, and payer-specific utilization review requirements Submit and monitor payer notifications for admissions, continued stay, and changes in status Follow authorizations from initial notification through approval and additional authorized days, including entering and monitoring approved bed days in UM navigator Proactively engaged in obtaining auth approvals and continued follow-up as needed for approval/denials Communicates with insurance companies regarding the medical necessity of admissions and provides clinical documentation and reviews as requested for purposes of ongoing authorization of hospital stays. Communicate discharge information and clinical updates to payers as required daily. Communicate with the attending physician or nursing staff, when needed, to address the appropriate level of care, and order changes. Collaborate with CML and UM staff to deliver appropriate Medicare forms to patients when required (e.g., Code 44, Code W2, and Hospital Issued Notices of Non-Coverage). Keeps Patient Registration and Patient Financial Services informed of any changes in admission status, working toward accurate capture of admission status prior to initial billing. Continually assesses clinical services for appropriateness for continued stay. Serves as a resource and actively provides education for physicians related to Medicare and third-party payor billing requirements, correct admission status, and documentation supporting medical necessity. Participates in the Utilization Review Committee. Assists UM RN Lead in medical necessity denial and appeals processes, ensuring prompt and accurate follow-up to ensure resolution and timely billing. Documents actions taken in the patient financial record and clinical review in UM navigator. Qualifications What You’ll Need: Knowledge of principles that relate to the position, including regulations and accreditation standards that pertain to Utilization management Aptitude in verbal and written communication, including ability to communicate with persons in all age groups Associate's degree or higher in Health Information management preferred Possession of current applicable certification and registration preferred – RHIT Possession of United States proof of citizenship or right to work in the United States Possession of a driver license or analogous identification Willingness to participate in Hospital orientation and educational in-service Minimum of 2 years of experience in a similar hospital-related position with utilization experience preferred. Must reside in Oregon. Benefits for Eligible Positions: Medical, Vision and Dental Insurance PTO and holiday pay Employee Referral Program 401(k) Retirement Life Insurance Long Term Disability Employee Discounts Bilingual Pay Differential for eligible positions Public Service Loan Forgiveness for eligible positions Tuition Assistance for eligible positions Why Santiam Hospital? At Santiam Hospital & Clinics, we pride ourselves on fostering a supportive and inclusive work environment where every team member is valued and empowered to make a difference. Our commitment to excellence in patient care is matched by our dedication to employee growth and well-being. As part of our team, you’ll have access to cutting-edge medical technology, ongoing professional development opportunities, and a collaborative culture that encourages innovation and teamwork. Join us at Santiam Hospital & Clinics, where your skills and compassion will be appreciated, and together, we can make a positive impact on the health and lives of our community. With 12 clinics offering 8 specialties, you’ll be part of a diverse and dynamic healthcare community. We’re proud to have been named the 2025 Best Place to Have a Baby, Best Hospital as well as receiving accolades for our Surgery Center, Medical Facility and Women’s Clinic, reflecting our unwavering commitment to providing exceptional care for our patients. Santiam Hospital & Clinics is a drug-free workplace in accordance with the Drug-Free Workplace Act of 1988 and an EEO Affirmative Action Race/Sex/Sexual Orientation/Gender Identity/National Origin/Veteran/Disability Employer.