Similar Jobs
See allUtilization Management Specialist
Logan Health
US
RN
Social Work
Communication
UTILIZATION REVIEW SUPERVISOR
Guidehealth
US
Case Management
Managed Care
Health Insurance
UM Medical Director
UM
Utilization Management
Medicare Advantage
Clinical Review
Medical Director-Utilization Management- Independent Contractor
Capital Blue Cross
US
Utilization Review
Quality Management
Accreditation
Clinical Care Manager- Utilization Review
Guidehealth
US
Utilization Review
Managed Care
Microsoft 365
Function/Duties of Position:
- Reviews pre-admissions for correct classification and admission order.
- Performs Utilization Review for each patient on their assigned daily census using established medical necessity guidelines.
- Communicates with payers regarding authorization and medical necessity, utilizing excellent negotiating skills.
Required Qualifications:
- Unencumbered Oregon RN license
- Three years of UM/UR experience required
- ADN Graduates: Associate Degree in Nursing from an accredited program 30 days before the start date.
Additional Details:
- Comprehensive health care plans are covered at 100% of the cost for full-time employees and 88% for dependents.
- Vacation - 192 to 288 hours per year depending on length of service, prorated for part-time
- Holidays - up to 64 holiday hours per calendar year
Oregon Health & Science University
Oregon Health & Science University values a diverse and culturally competent workforce. They are an equal opportunity, affirmative action organization that does not discriminate against applicants.