Utilization Review Specialist Senior - Emergency Department
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Title: Utilization Review Specialist Senior - Emergency DepartmentLocation: FL-Riverview-St. Josephs SouthJob Number: 216300
The Senior Utilization Review Specialist functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services. Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials. Preferred experience includes Critical Care or Emergency Nursing RN.
Qualifications:
Certifications and Licensures
RequiredRN (Registered Nurse)
PreferredACM (Case Management)
PreferredCCM (Case Manager)
Education
RequiredAssociate'sNursing
OrBachelor'sNursing
PreferredMaster'sNursing
OrMaster'sBusiness
Experience
Required2 yearsUtilization Review
Or2 yearsCase Management
Or4 yearsRegistered Nurse
PreferredReference summary for details
Specific Skills
RequiredCustomer service skills
RequiredWritten and verbal communication skills
RequiredInterpersonal skills
RequiredWork with a team
RequiredCritical thinking skills
RequiredKnowledge of regulatory standards appropriate to position
RequiredWork independently
RequiredDelegation skills
RequiredComputer skills appropriate to position
RequiredOrganizational skills
Schedule: Varies
Shift: Nights
Shift Hours: 7:15 PM - 6:45 AM
Weekend Work: Every Other
On Call: No
Employment Status: ACTIVE PART TIME
Equal Opportunity Employer Veterans/Disabled