McLaren Health Care Utilization Review Specialist in Bay City, Michigan

18-2829

Post Date

6/1/2018

Title

Utilization Review Specialist

Job Family

Health Professional

Subsidiary

McLaren Bay Region

Department

91570 - Case Management

Location

Bay City Region

City

Bay City

State

MI

Full Time

Yes

Hours per 2 week pay period

0

Schedule

DAYS

Weekends and/or Holidays Required

Yes

On Call Required

No

Description

JOB SUMMARY

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.

Qualifications:

Required

  • 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

Preferred:

  • 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rescinded, and they will be disqualified from reapplying for employment for six (6) months from the date of the health screening.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.

Apply On-line

Send This Job to a Friend

© All rights reserved