Mar 05, 2021

Utilization Review Specialist Senior

  • BayCare Health System
  • St. Petersburg, FL, USA

Job Description

Utilization Review Specialist Senior(Job Number: 208084) 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 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 service skills Required Written and verbal communication skills Required Interpersonal skills Required Work with a team Required Critical thinking skills Required Knowledge of regulatory standards appropriate to position Required Work independently Required Delegation skills Required Computer skills appropriate to position Required Organizational skills     Organization: 1105-ST ANTHONY'S HOSPITAL Primary Location: FL-St. Petersburg-St. Anthony’s Hospital Schedule: Varies Shift: Days Shift Hours: 8:00 AM - 4:30 PM Weekend Work: Occasional On Call: No Employment Status: ACTIVE FULL TIME Equal Opportunity Employer Veterans/Disabled