Utilization Management Specialist

6 days ago


Chattanooga, Tennessee, United States Medicine Journal Full time

Medicine Journal seeks a skilled Utilization Management Specialist to join our team. With a focus on ensuring the quality and efficiency of patient care, this role is ideal for an experienced nurse with a strong background in utilization management.

Job Summary

We are looking for a highly motivated individual who can interact effectively with interdisciplinary staff to complete the process of utilization management. As a Utilization Management Specialist at Medicine Journal, you will be responsible for initial and concurrent review of patient records, obtaining information from physicians, and determining medical necessity of admissions, observations, and procedures.

Responsibilities

  • Determine medical necessity of admissions, observations, and procedures
  • Responsible for observation management and capturing of avoidable days
  • Participate in gathering and reporting data for performance improvement activities
  • Takes responsibility for department and organization objectives

Requirements

  • Current license to practice nursing in the State of Tennessee
  • Prior experience in utilization management
  • Knowledge of managed care practices with minimum of three years experience and evidence of clinical knowledge and familiarity with regulatory and insurance reimbursement issues

What We Offer

We offer a competitive salary range of $80,000 - $110,000 per year, depending on experience, as well as a comprehensive benefits package that includes health, dental, and vision insurance, 401(k) matching, and paid time off.



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