RN Utilization Management & Review Specialist

OSF HealthCare • Peoria, IL

5h • Hybrid

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. This has the potential to be a fully remote-working position after 6 months of training and at the discretion of leadership. This nurse must live within traveling distance of an OSF facility.

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 to address appropriate admission status.
• 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.

Benefits

• Comprehensive and market-competitive total rewards package
• Benefits, compensation, recognition and well-being offerings
• Focus on the whole person and engage with their current stage of life and career

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees