RN Utilization Review Specialist Priority Health
On-site · Grand Rapids, Michigan, United States
Grand Rapids, Michigan, United StatesOn-siteFull TimeMid LevelBachelors DegreeLarge
Type
Full Time
Level
Mid Level
Education
Bachelors Degree
Company size
Large
Job Summary
RN Utilization Review Specialist responsible for evaluating preservice and concurrent requests to ensure appropriate use of acute medical and/or behavioral health services, educating staff on utilization management, providing financial/UM information to care teams, coordinating with physicians, social workers and home health agencies, performing medical necessity reviews, ensuring regulatory-compliant documentation, and contributing to quality improvement and patient flow through the continuum.
Required Qualifications
- Bachelor's Degree or equivalent Nursing
- Registered Nurse (RN) - State of Michigan
- 5 years of relevant experience in acute care, behavioral health, utilization management, discharge planning or related
- Experience in designing patient-centered care plans or related work
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