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Utilization Review Spec RN
The Utilization Management (UM) Specialist RN is responsible for concurrent utilization management activities to a defined patient population. The UM Specialist is a link between the patient, health care team, organization, and payors during the patient's hospital stay. The UR Specialist facilitates optimal reimbursement through accurate certification and complete chart documentation. Completes admission and continued stay reviews based on UR criteria. This position participates in a collaborative team approach and works independently, as well as cooperatively and collaboratively with health care staff and management. Work situations require specialized knowledge, judgment and skill. This position requires organization and interpretation of information relating to a wide variety of policies, procedures and programs. Work situations are frequently non-routine requiring analysis and the use of discretion and good judgment in decision making. This position requires a services oriented, caring professional individual with flexibility to work across all boundaries. This position requires extensive internal and external contacts with all levels of staff and management.
Five years of clinical experience required; utilization management and/or insurance industry experience preferred
Graduate from an accredited RN BSN program
Currently licensed as an RN (State of Washington). Must have BSN or agree to sign an education agreement
LPN or RN Candidate: Required: Coding experience. Ideal candidate must have actual coding experience. Preferred: Operating Room/Surgical experience