Utilization Management and Review Specialist

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Pay range for this position is $34.25 - $51.13/hour. Actual pay is based on years of licensure. This is a Salaried position.

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.

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.