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Optum
Wadesboro, North Carolina
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AdventHealth
Orlando, Florida
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Utilization Review Specialist, RN
The RN Utilization Review Specialist serves as a liaison between Shriners Hospitals and external payers on issues related to intensity of service and severity of illness and denial management activities. Conducts accurate and timely initiation and completion of payer specific information and communications flow to facilitate appropriate length of stay (LOS) and payer reimbursement. (This position is remote.) POSITION RESPONSIBILITIES: Clinical Review - 25% Develops a clinical review based upon information in the patient's medical record that incorporates the severity of illness, intensity of service, plan of care, and discharge plan; and documents this clinical Communicates with Care Manager and/or physician t
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