Utilization Management Specialist
3 weeks ago
At St. Tammany Health System, we are committed to delivering world-class healthcare close to home. As a Utilization Management Specialist, you will play a critical role in ensuring that our patients receive the most appropriate and effective care.
Job Summary:The Utilization Management Specialist is responsible for reviewing medical records to determine the appropriateness and medical necessity of admission, continued stay, and use of resources. This role requires strong analytical and communication skills, as well as the ability to work effectively in a fast-paced environment.
Key Responsibilities:- Review medical records to determine medical necessity and appropriateness of care
- Assess the use of resources and identify opportunities for improvement
- Collaborate with healthcare teams to develop and implement effective care plans
- Communicate with patients, families, and healthcare providers to ensure seamless care transitions
- Graduate of an accredited school of nursing with current RN licensure
- Minimum 5 years of hospital nursing experience, with a focus on utilization management
- Strong analytical and communication skills, with the ability to work effectively in a fast-paced environment
- Ability to maintain confidentiality and handle sensitive information
This role requires good physical health, with the ability to stand, sit, or walk for long periods of time. Lifting at least 10 pounds is required.
We are an equal opportunity employer and welcome applications from diverse candidates. If you are a motivated and detail-oriented individual with a passion for healthcare, we encourage you to apply for this exciting opportunity.
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