Jun 03, 2022

Utilization Review Specialist Senior

  • BayCare Health System
  • Plant City, FL, USA

Job Description

Utilization Review Specialist Senior(

Job Number:

220269)

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
RequiredAssociate'sNursing
OrBachelor'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

: 5105-SOUTH FLORIDA BAPTIST HOSPITAL

Primary Location

: FL-Plant City-South Florida Baptist Hospital
Schedule: Varies

Shift

: Days
Shift Hours: 8:00 AM - 4:30 PM
Weekend Work: Occasional
On Call: No
Employment Status: ACTIVE PRN

Does this position fall under CMS guidelines for COVID19 vaccine or exemption?” Yes

How often will this team member be working remotely? Never (Onsite Only)

Equal Opportunity Employer Veterans/Disabled