DescriptionReports to the Manager of UMR. Performs Utilization Management and Review (UMR) activities. Evaluates patient care and activities against objective criteria in an effort to take a proactive approach in addressing appropriate admission status of each patient, 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. All work processed and completed is intended to improve quality of care and to reduce morbidity and mortality, is considered to be confidential and protected from discovery by subpoena. Must have a personal commitment to performance improvement, patient safety, patient satisfaction and promotion of high quality and cost effective care.
2 years clinical experience in an acute care or Managed Care setting.
Current Illinois and/or Michigan State license as a Registered Nurse.
Working knowledge of a clinical EMR system and Microsoft Office applications.
Able to work independently and efficiently with excellent time management skills.
Work requires substantial interpersonal skills to develop and maintain cooperative working relationships with personnel from other departments.
EQUAL OPPORTUNITY EMPLOYER
Applicants will be afforded equal opportunity without discrimination because of race, color, religion, sex, marital status, national origin or ancestry, age physical or mental handicap unrelated to ability or an unfavorable discharge from military service.
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Job seekers will be afforded equal opportunity regardless of their race, ethnicity, veteran status or disability status.