Role Description
The Utilization Management and Review Specialist (UMR Specialist) evaluates patient care and activities against objective criteria in an effort to take a proactive approach in addressing appropriate admission status of each patient. In addition, the UMR Specialist will:
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Identify utilization issues involving under or over utilization of services.
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Resolve and/or refer utilization issues in accordance with established procedures.
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Review medical records to determine appropriateness and medical necessity of admission and hospital stay and use of ancillary services.
This position has the potential to be fully remote after 6 months of training and at the discretion of leadership. The nurse must live within traveling distance of an OSF facility.
Qualifications
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Education: Bachelor's Degree in Nursing must be obtained within 3 years of date of hire into role.
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Experience: 2 years of clinical experience in an acute care or managed care setting.
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Licensure/Certifications: Current state license as Registered Nurse (IL).
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Other skills/knowledge: Working knowledge of clinical EMR system.
Requirements
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Education: Bachelor's Degree in Nursing.
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Other Skills/Knowledge: Working knowledge of Microsoft Office applications.
Benefits
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Comprehensive and market-competitive total rewards package that includes benefits, compensation, recognition, and well-being offerings.
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Pay range for this position is $34.25 - $51.13/hour. Actual pay is based on years of licensure.
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This is a salaried position.
Company Description
OSF HealthCare is dedicated to providing Mission Partners with a comprehensive and market-competitive total rewards package that focuses on the whole person and engages with their current stage of life and career.
