UTILIZATION SPECIALIST-E.D.
On-siteMiddleburg Heights, Ohio, United States
Job Summary
Formulate patient status recommendations for observation or inpatient care after reviewing assessments during the workup and collaborating with ED physicians. Ensure the daily surgery schedule remains current with correct status and coding while applying screening criteria to identify patients for appropriate admission processes. Collect data and clinical review summaries for utilization review and quality assessment, then share this information with insurance companies to obtain certification and prevent payment denials. Communicate with physicians, hospital staff, outside agencies, and patients regarding assigned levels of care and resource utilization to reduce financial risk and exposure.
Required Qualifications
- Graduation from an accredited School of Nursing
- Minimum of five (5) years of recent experience in clinical nursing or related nursing fields
- Current licensure by Ohio State Board of Nursing
Desired Qualifications
- BSN graduate preferred
- Previous Care Management, Case Management or Utilization Management Experience
- Previous experience with screening criteria (i.e., Interqual, MCG)
- Excellent critical thinking and communication skills
- Strong computer skills
- ACM/CCM Certification helpful
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.