UTILIZATION REVIEW SPECIALIST SENIOR

BayCare Clearwater, FL

About the Job

Description:

The Senior Utilization Review Specialist functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services. The Senior Utilization Review Specialist is responsible for the oversight of the utilization Review Specialists. Perform other duties as assigned by the supervisor. Critical Care or Emergency Nursing RN preferred.



Qualifications:

Certifications and Licensures

RequiredRN (Registered Nurse)
PreferredUtilization Management

Education
RequiredAssociate'sNursing
OrDiplomaNursing
PreferredBachelor'sNursing

Experience
Required2 yearsUtilization Review
Or4 yearsRegistered Nurse
PreferredReference summary for details

Specific Skills
RequiredCustomer service skills
RequiredWritten and verbal communication skills
RequiredInterpersonal skills
RequiredWork with a team
RequiredCritical thinking skills
RequiredKnowledge of regulatory standards appropriate to position
RequiredWork independently
RequiredDelegation skills
RequiredComputer skills appropriate to position
RequiredOrganizational skills