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Utilization Management

2 months ago

Peoria, United States OSF HealthCare Full time
Overview

Pay range for this position is $33.36 - $50.34/hour. Actual pay is based on years of licensure.

POSITION 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.

This position may have a remote-working schedule at the discretion of leadership after training and orientation are complete.

Qualifications

REQUIRED 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


OSF HealthCare is an Equal Opportunity Employer.