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Department Overview:
- The Utilization Management Department enacts the hospital UR plan, assessing medical necessity of admission and continued stay.
- Provides clinical information to third-party payers to secure authorization and manages denials and outlier reviews.
Role Responsibilities:
- Conduct robust utilization review using established criteria and work with payers for ongoing authorization.
- Collaborate with care management, physician advisor, and revenue cycle teams to address denials and improve denial prevention.
- Maintain coverage for OHSU hospital units and contracted collaborative sites such as Adventist Health and Columbia Memorial.
Qualifications:
- Proficiency in Microsoft Office (Word, Excel, PowerPoint) and use of Interqual or MCG criteria.
- Excellent verbal and written communication skills, including composing persuasive arguments and conflict resolution.
- Demonstrated leadership experience (e.g., charge nurse, nurse manager) and ability to work independently.
Oregon Health & Science University
OHSU is Oregon's only public academic health center, providing patient care, groundbreaking research, and training health professionals. As Portland's largest employer, we offer diverse opportunities in a system of hospitals and clinics, committed to building an anti-racist, multicultural institution.