RN Utilization Review Specialist

4 weeks ago


Columbus, Ohio, United States Trinity Health Full time
Job Summary:

The RN Utilization Review Specialist ensures that services are delivered in a manner that balances quality of care with efficiency, cost-containment and compliance. This role conducts Utilization Management review for Inpatient and Outpatient cases, analyzes and summarizes medical utilization and medical chart audit results, and compares clinical information to determine appropriateness of service.

Responsibilities:

Conduct Utilization Management review for Inpatient and Outpatient cases
Analyze, summarize, and concisely report medical utilization and medical chart audit results
Compare clinical information to determine appropriateness of service and to document all related information according to department policies and procedures
Coordinate with the utilization review, case management, and discharge planning colleagues as needed
Collaborate with medical directors/providers and other operational departments regarding applicable case-specific issues

Requirements:

Graduate of an accredited school of nursing
Current license to practice as a Registered Nurse (RN) in the State of Ohio
Three (3)+ years of relevant clinical work experience required; Two (2)+ years' experience in utilization review, discharge planning, or case management preferred

What We Offer:

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. We are committed to diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. We are an Equal Opportunity Employer and welcome all qualified applicants.

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