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. The Senior Utilization Review Specialist is responsible for the oversight of the utilization Review Specialists.
Perform other duties as assigned by the supervisor. Critical Care or Emergency Nursing RN preferred.
Certifications and Licensures
RequiredRN (Registered Nurse)PreferredUtilization Management
Utilization ReviewOr4 years
Registered NursePreferredReference summary for details
Specific SkillsRequiredCustomer service skills
RequiredWritten and verbal communication skills
RequiredWork with a team
RequiredCritical thinking skills
RequiredKnowledge of regulatory standards appropriate to position
RequiredComputer skills appropriate to position
Baycare Health System, Inc