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BayCare Health System Utilization Review Specialist Senior - Emergency Department in TAMPA, Florida

Title: Utilization Review Specialist Senior - Emergency Department Location: FL-Tampa-St. Joseph's Hospital Job Number: 213606

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. Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials. Preferred experience includes Critical Care or Emergency Nursing RN.

Qualifications:

Certifications and Licensures

RequiredRN (Registered Nurse)

PreferredACM (Case Management)

PreferredCCM (Case Manager)

Education

RequiredAssociate'sNursing

OrBachelor'sNursing

PreferredMaster'sNursing

OrMaster'sBusiness

Experience

Required2 yearsUtilization Review

Or2 yearsCase Management

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

Schedule: Varies

Shift: Nights

Shift Hours: 7:15 PM - 6:45 AM

Weekend Work: Every Other

On Call: No

Employment Status: ACTIVE FULL TIME

Equal Opportunity Employer Veterans/Disabled

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