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.
2 years of clinical experience in an acute care or managed care setting
Current state license as Registered Nurse
Working knowledge of clinical EMR system
Working knowledge of Microsoft Office applications
Job seekers will be afforded equal opportunity regardless of their race, ethnicity, veteran status or disability status.
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