RN Utilization Management & Review Spec
About The Position
The Utilization Management and Review Specialist (UMR Specialist) evaluates patient care and activities against objective criteria in an effort to take a proactive approach in addressing appropriate admission status of each patient. In addition the UMR Specialist will identify utilization issues involving under or over utilization of services, resolves and/or refers utilization issues in accordance with established procedures. Reviews medical records to determine appropriateness and medical necessity of admission and hospital stay and use of ancillary services. Behavioral Health: This position supports the Behavioral health department at OSF Sacred Heart Medical Center-Urbana
Requirements
- Bachelor's Degree in Nursing must be obtained within 3 years of date of hire into role
- 2 years of clinical experience in an acute care or managed care setting
- Current state license as Registered Nurse (IL)
- Working knowledge of clinical EMR system
Nice To Haves
- Bachelor's Degree in Nursing
- Working knowledge of Microsoft Office applications
Responsibilities
- Evaluates patient care and activities against objective criteria in an effort to take a proactive approach in addressing appropriate admission status of each patient
- Identifies utilization issues involving under or over utilization of services
- Resolves and/or refers utilization issues in accordance with established procedures
- Reviews medical records to determine appropriateness and medical necessity of admission and hospital stay and use of ancillary services
- Supports the Behavioral health department at OSF Sacred Heart Medical Center-Urbana
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
