What are the responsibilities and job description for the Utilization Management and Review Specialist position at OSF HealthCare?
Pay range for this position is $32.83 - $48.76/hour. Actual pay is based on years of licensure.
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.
Able to work remote at leadership discretion if feel performance meets expectations after 6 months of start date.
Qualifications
REQUIRED QUALIFICATIONS:
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
PREFERRED QUALIFICATIONS:
Education:
- Bachelor's Degree in Nursing
Other Skills/Knowledge:
- Working knowledge of Microsoft Office applications
OSF HealthCare is an Equal Opportunity Employer.
Salary : $33 - $49
