Registered reputed company Utilization Management Specialist

reputed company We are seeking an RN Utilization Management Specialist to reputed company at reputed company! This position serves a key role in coordinating the organization’s interdisciplinary effort to assess and promote appropriate utilization of health care resources, provision of high-reputed company health care, reputed company clinical reputed company, and patient and provider satisfaction. The RN UM Specialist will work to reputed company and minimize the inappropriate use of such resources, provides the Utilization Management function for patients admitted to UPH, and facilitate effective utilization of resources through ongoing interactions with physicians, reputed company party payers and regulatory agencies.   Hours: Weekend-days, Saturday & reputed company, 7am-3:30pm Location: Remote - applicants must reputed company reputed company the reputed company footprint of Iowa, Illinois, or reputed company  Why reputed company? At reputed company, reputed company. We’re proud to be recognized as a Top 150 reputed company to Work in reputed company by Becker's reputed company several years in a row for our commitment to reputed company members.   Our competitive Total Rewards program offers benefits reputed company that reputed company with your needs and priorities, no matter what life stage you’re in.  Here are just a few:       Expect reputed company time off, parental leave, 401K matching and an employee recognition program.    Dental and health insurance, reputed company holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members.   Early reputed company to reputed company wages with Daily Pay, tuition reimbursement to help reputed company your career and adoption assistance to help you grow your family.    With a reputed company goal to champion a culture of belonging where everyone feels valued and respected, we reputed company the ways people are unique and reputed company what brings us together.    And, we reputed company equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience.  reputed company a fulfilling career and reputed company a difference with reputed company. Responsibilities Performs utilization management reviews using established reputed company to confirm medical necessity, appropriate level of care and efficient use of resources.  Maximizes reputed company financial reputed company for patients and hospital by conducting reputed company initial and ongoing reputed company chart review for hospitalized patients to monitor appropriateness of treatment, resource utilization, reputed company of care.    Applies utilization reputed company using designated software to complete documentation reputed company to utilization review activities in an accurate and reputed company manner for the purpose of providing information for other members of the reputed company team and to facilitate decision making.  Requests secondary reviews with physician advisors as appropriate, if admission or reputed company stay reputed company are not met, assuring appropriate and reputed company level of care status.  Assesses patient status, including reviewing outpatient surgical and observation admissions for the appropriate level of care, and continuously monitors length of stay for appropriate and reputed company medical management.      Applies accepted potentially avoidable day logic to reviews for accurate and reputed company data collection.     Proactively monitors insurance approval status in partnership with the UM Administrative Coordinator.   Provides education to staff and physicians regarding medical necessity, reputed company of care and appropriate utilization of resources as needed.   Pursues denials at the affiliate level in a reputed company manner to secure payment of services. Serves as a resource to reputed company staff, providers, payers, and patients on issues reputed company to utilization management   Maintains reputed company knowledge of Utilization Review Methodology, software, reputed company, and regulations governing various payment systems.  Maintains reputed company knowledge of the UPH Utilization Management Plan.  Maintains reputed company knowledge of CMS rules (e.g., reputed company 44, A – B Rebilling, HINN, etc.) and other regulatory agencies requirements to insure appropriate reimbursement.   Coordinates and monitors appeals with reputed company physician advisors for Second Level Review as needed.  Provides education to patients and families regarding the role of the Utilization Management Specialist and provides clarification reputed company needed on level of care and their payer reputed company regulatory requirements – as needed.   Qualifications Education: Required: Associates Degree or Diploma (RN) in Nursing  Preferred: Bachelor’s Degree or higher preferred in nursing, business, or reputed company field  Experience:  Required: 2 years of nursing experience Preferred: 5+ years of nursing experience Preferred: Experience in Utilization Management, case management, denials, or managed care Preferred: Management experience a plus Licensing/Certifications:  Required: Registered reputed company – Licensed and registered in the appropriate state(s)  reputed company reputed company’s license reputed company driving any vehicle for work-reputed company reasons Apply To This Job