BayCare Health System
Lutz, FL, USA
Utilization Review Specialist Senior(Job Number: 209608)
Description
The Senior Utilization Review Specialist functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services. Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials. Preferred experience includes Critical Care or Emergency Nursing RN.
Qualifications
Certifications and Licensures
Required RN (Registered Nurse)
Preferred ACM (Case Management)
Preferred CCM (Case Manager)
Education
Required Associate's Nursing
Or Bachelor's Nursing
Preferred Master's Nursing
Or Master's Business
Experience
Required 2 years Utilization Review
Or 2 years Case Management
Or 4 years Registered Nurse
Preferred Reference summary for details
Specific Skills
Required Customer...
Jan 17, 2021