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Urgent! Utilization Review Specialist - VNA Job Opening In Pittsfield – Now Hiring Berkshire Health Systems

Utilization Review Specialist VNA



Job description

  • DEFINITION/PRIMARY FUNCTIONS The Utilization Program Specialist is responsible for evaluating the necessity and appropriateness of services to ensure that they are effective and cost efficient.

    The Utilization Program Specialist works in tandem with the Clinical Manager to assist the clinical staff with case management and ensure care is delivered according to BVNA standards/pathways and regulatory requirements.

    He/she provides direction and acts as a resource for Clinical Managers and staff regarding reimbursement.

    The Utilization Program Specialist organizes, complies and translates medical information into medical codes according to home care coding conventions.

  • POSITION QUALIFICATIONS (Minimum qualifications are required unless stated otherwise.) Experience: Minimum of 3 years of work experience in a certified home health agency.

    Experience with quality assurance or utilization review preferred.

    Knowledge of current regulations governing third party reimbursement for home health required.

    Ability to cooperate, guide and instruct a multi-disciplinary team required.

    Ability to exercise independent judgement; demonstrated time management skills; demonstrated ability to facilitate smooth flow of home care patients.

    Demonstrated ability to conform with Service Excellence Standards Demonstrated knowledge of Conditions of Participation in home care.

    Demonstrated general computer skills required.

    Demonstrated knowledge of Windows, including Microsoft Word, Excel and E-mail preferred.

    Education and Training: BSN nursing strongly preferred.

    Certification in Current version of Home Health coding required.

    License, Certification & Registration: RN License- Currently licensed as an RN in the state of Massachusetts DRIVER - Driver's License Other Requirements: Ability to maintain confidentiality.

    Ability to be flexible regarding work hours.

    Knowledge of community resources.

    Demonstrated problem-solving ability.


  • Required Skill Profession

    Other Healthcare Practitioners And Technical Occupations



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    • Real-time Utilization Review Jobs Trends in Pittsfield, United States (Graphical Representation)

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    • The Work Culture

      An organization's rules and standards set how people should be treated in the office and how different situations should be handled. The work culture at Berkshire Health Systems adheres to the cultural norms as outlined by Expertini.

      The fundamental ethical values are:
      • 1. Independence
      • 2. Loyalty
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      • 5. Accountability
      • 6. Respect for human rights
      • 7. Obeying United States laws and regulations
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    • Interview Tips for Utilization Review Specialist VNA Job Success
      Berkshire Health Systems interview tips for Utilization Review Specialist   VNA

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      Final Thought:

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