Utilization Management Specialist - Washington
3 days ago

Job summary
The Utilization Management Specialist performs utilization management activities including admission review concurrent review retrospective chart review and clinical systems review to measure clinical performance and utilization management issues affecting reimbursement for the patient s hospital stay or visit. The specialist conducts medical record reviews provides clinical information to payers collects and reports utilization management data interacts with the clinical team physician advisor and engages in special projects.Qualifications
* Completion of an accredited nursing program (RN) or LCSW required BSN preferred* Minimum of five years of nursing experience or five years of licensed social work experience with preference for utilization management care management appeals and/or clinical experience with preference for MCG knowledge and experience* Current and unrestricted Maryland or compact RN license or Social Work License for Psychiatry requiredJob description
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