Pay range for this position is $34.25 - $51.13/hour. Actual pay is based on years of licensure. This is a Salaried position.
OverviewPOSITION 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.
QualificationsREQUIRED 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
