Utilization Management and Review Specialist RN
About The Position
POSITION SUMMARY: 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.
Requirements
- Education: Bachelor's Degree in Nursing must be obtained within 3 years of date of hire into role.
- Experience: 2 years of clinical experience in an acute care or managed care setting
- Licensure/Certifications: Current state license as Registered Nurse
- Other skills/knowledge: Working knowledge of clinical EMR system
Nice To Haves
- Education: Bachelor's Degree in Nursing
- Other Skills/Knowledge: Working knowledge of Microsoft Office applications
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What This Job Offers
Job Type
Full-time
Industry
Religious, Grantmaking, Civic, Professional, and Similar Organizations
Number of Employees
1-10 employees
