Role OverviewThe RN Utilization Review Specialist provides health information and acts as a resource for providers to ensure appropriate use of preservice and concurrent acute medical and/or behavioral health care services. They assess the appropriateness of requests for admissions and continued stay, educate medical staff, and make recommendations for financial and utilization management.
What You Will Do
The RN Utilization Review Specialist will assess and interpret clinical information, assist in case management of complex patient populations, and communicate with physicians and hospital personnel. They will also identify quality indicators, ensure documentation and processes are consistent with regulatory standards, and collaborate with Medical Directors.
Why It Might Be a Fit
This role requires a Registered Nurse with 2-5 years of relevant experience in acute care, clinical nursing, or related experience. The ideal candidate will have strong problem-solving skills, be able to interpret clinical information, and have experience with utilization management and discharge planning.
Requirements
- Bachelor's Degree or equivalent Nursing or a health care related field
- 2 years of relevant experience acute care, clinical nursing, preferably multiple clinical settings, or related experience
- 5 years of relevant experience in acute care, multiple clinical settings or behavioral health with utilization management, discharge planning designing patient centered care plan or related work
- Registered Nurse (RN) - State of Michigan Upon Hire required
Benefits
- Comprehensive benefits package
- On-demand pay program powered by Payactiv
- Discounts directory
- Optional identity theft protection
- Home and auto insurance
- Traditional and Roth retirement options
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