| Responsibilities: |
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| Utilization Review Specialist Job in Madison, Wisconsin
Coordinate and facilitate correct identification of patient status. Coordinate and integrate UM functions Collaborate with all members of the healthcare team, both internal and external customers. Participate in clinical performance improvement activities to achieve set goals. Demonstrate positive and professional written, verbal, and nonverbal communication skills. Apply advanced critical thinking and conflict resolution skills using creative approaches. |
| Work Experience: |
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| Minimum Five (5) years of relevant clinical nursing experience
An equivalent combination of education and experience will be considered Recent experience as an inpatient utilization review nurse or UM coordinator (Preferred) Excellent interpersonal communication, problem-solving, and conflict-resolution skills. Computer skills in word processing, database management, and spreadsheet are desirable. Knowledge in areas of Medicaid UM regulations, McKesson InterQual, Medicare Inpatient Only List, RAC, QIO, MAC, and Denial Management. |
| Education: |
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| Bachelor’s degree in Nursing
MS degree in Nursing or Health Care related field (Preferred) |
| Licenses & Certifications: |
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| Minimum RN licensed in the state of Wisconsin |
| Preferred: |
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| ACM (Accredited Case Manager) through AMCA (American Case Management Association).
CCM (Certified Case Manager) CCMC (Commission for Case Manager Certification). Board certification in Nursing Case Management (RN-BC) through ANCC (American Nurses Credentialing Centre). CPHQ (Certified Professional in Health Care Quality) through NAHQ (National Association of Health Care Quality) |
