McLaren Health Care Utilization Review Specialist in Bay City, Michigan
Utilization Review Specialist
McLaren Bay Region
91570 - Case Management
Bay City Region
Hours per 2 week pay period
Weekends and/or Holidays Required
On Call Required
In conjunction with the admitting/attending physician, the UR Specialist RN assists in determining the appropriate admission status based on the regulatory and reimbursement
requirements of various commercial and government payers. Partners with the health care team to ensure reimbursement of hospital admissions is based on medical necessity and documentation is sufficient to support the level of care being billed. Conducts concurrent
reviews as directed in the hospital’s UR Plan of medical records to ensure criteria for admission and continued stay are met and documented. Along with other health care team members, monitors the use of hospital resources and identifies delays. Reports
delays to leadership for resolution.
Nursing degree from an accredited educational institution
State of Michigan licensure as a Registered Nurse (RN)
Two years of recent clinical or utilization management experience
Bachelor’s degree in nursing.
Three years of recent case management or utilization management experienc
To provide a safe, healthy environment for our patients, employees and visitors, as of January 1, 2013 McLaren Bay will no
longer hire individuals who use nicotine and will test for nicotine during the pre-employment process. Individuals whose health screening results are verified positive for tobacco/nicotine use will be disqualified from employment, their job offer will be
rescinded, and they will be disqualified from reapplying for employment for six (6) months from the date of the health screening.
- Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.
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