The RN Utilization Management Specialist coordinates communication with admitting financial counselors, case management team, providers, patient financial services, and payers to ensure all services provided by the hospital are authorized by appropriate payer. The RN Utilization Management Specialist confers and reviews with physicians on medical admitting information to assess medical necessity and uses evidence-based criteria to consider the anticipated length of stay, level of care, intensity of service to support access to services. The RN Utilization Management Specialist facilitates timely transmission of admission, concurrent and discharge reviews to the appropriate payer to ensure all days are authorized and documented. Clinical reviews and continued stay authorizations will be documented in the appropriate electronic system.

Qualifications

• Req Bachelor's degree Nursing BSN
• Req 3 years Clinical experience.
• Req 3 years Case management experience in an acute care hospital setting
• Req 1 year Experience utilizing InterQual Criteria in CERME format.
• Req Must have excellent communication skills, including the ability to speak, read and write English proficiently.
• Req Knowledge of medical procedures and conditions and ability to understand, follow and successfully perform duties, including whole blood collection, and apheresis procedures, in accordance with administrative and clinical policies, regulations and procedures.

About the Hospital

At Keck Medicine of USC, diversity means recognizing the richness of our differences and celebrating them together.

Our nurses enjoy a wide array of competitive benefits, including free tuition at USC for both employees and their families.

We provide exceptional healthcare, retirement benefits and quality of life programs designed to help you make the most of your experience at Keck Medicine of USC; and discounts on a wide variety of services, including public transportation passes, campus fitness center memberships and event tickets.