Jun 04, 2021

Utilization Review Specialist Senior

  • BayCare Health System
  • Clearwater, FL, USA

Job Description

Utilization Review Specialist Senior(

Job Number:

211615)

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
RequiredRN (Registered Nurse)
PreferredACM (Case Management)
PreferredCCM (Case Manager)

Education
RequiredBachelor'sNursing
PreferredMaster'sNursing
OrMaster'sBusiness

Experience
Required2 yearsUtilization Review
Or2 yearsCase Management
Or4 yearsRegistered Nurse
PreferredReference summary for details

Specific Skills
RequiredCustomer service skills
RequiredWritten and verbal communication skills
RequiredInterpersonal skills
RequiredWork with a team
RequiredCritical thinking skills
RequiredKnowledge of regulatory standards appropriate to position
RequiredWork independently
RequiredDelegation skills
RequiredComputer skills appropriate to position
RequiredOrganizational skills

Organization

: 2100-MORTON PLANT HOSPITAL ASSOC

Primary Location

: FL-Clearwater-Morton Plant Hospital
Schedule: Monday, Tuesday, Wednesday, Thursday, Friday, Varies

Shift

: Days
Shift Hours: 8:00 AM - 4:30 PM
Weekend Work: Every
On Call: No
Employment Status: ACTIVE FULL TIME

Equal Opportunity Employer Veterans/Disabled