Utilization Review Specialist Senior

BayCare
Full Time
Winter Haven, FL
Posted
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Job description
Description:


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.

This is full time 7:00 PM - 7:00 AM at Winter Haven Hospital.


Qualifications:

Certifications and Licensures
Required
RN (Registered Nurse)

Preferred
ACM (Case Management)

Preferred
CCM (Case Manager)


Education
Required
Associate's
Nursing

Or
Bachelor's
Nursing

Preferred
Master's
Nursing

Or
Master's
Business


Experience
Required
2 years
Utilization Review

Or
2 years
Case Management

Or
3 years
Registered Nurse

Preferred
Reference summary for details


Specific Skills
Required
Customer service skills

Required
Written and verbal communication skills

Required
Interpersonal skills

Required
Work with a team

Required
Critical thinking skills

Required
Knowledge of regulatory standards appropriate to position

Required
Work independently

Required
Delegation skills

Required
Computer skills appropriate to position

Required
Organizational skills

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