OSF HealthCare
Location
Urbana, Illinois
The specialist evaluates patient care and admission status against objective criteria to ensure medical necessity. They identify and resolve utilization issues regarding the over or under-utilization of hospital services.
Requires a current Registered Nurse license and two years of clinical experience in acute or managed care. A Bachelor's Degree in Nursing is preferred or must be obtained within three years of hire.
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. Behavioral Health: This position supports the Behavioral health department at OSF Sacred Heart Medical Center-Urbana
Education: Bachelor's Degree in Nursing must be obtained within 3 years of date of hire into role.
Education: Bachelor's Degree in Nursing. Other Skills/Knowledge: Working knowledge of Microsoft Office applications. OSF HealthCare is an Equal Opportunity Employer.