Utilization Mgmt Nurse
Utilization Management Registered Nurse The ideal candidate will have a BSN and a background in Utilization Review Be able to do 25-28 reviews a day for 9 of the Advocate Aurora hospitals. Strong communication skills required to communicate with providers Familiarity with Milliman Care Guidelines a plus Position Requirements: Level of Education: Bachelor\s Degree in Nursing Years of Experience: 3+ Years of experience in clinical nursing Utilization Review case and/or quality management. Working knowledge in the use of Microsoft Office (Excel Outlook PowerPoint and Word) or similar products. Knowledge of the components of quality and acute care patient care needs specifically related to the area/function in which care management will be performed. Demonstrated working knowledge and accurate application of evidence based nationally recognized Utilization Review criteria as evidenced by achieving 80 percent or greater on the annual Inter Rater Reliability (IRR) competency exam. Critical thinking skills to analyze and synthesize clinical scenarios as it relates to application of medical necessity criteria. Excellent analytical and interpersonal communication skills necessary to interact with colleagues physicians and third~ party payers. Ability to foster and maintain effective professional relationships with physicians and other professionals in a direct and positive manner. Ability to manage conflict appropriately and communicating with others in a manner that aligns with Advocate Aurora\s Behaviors of Excellence initiatives. Ability to be flexible and function well in the everchanging fast~ paced heavily regulated health care/payer environment and to comply to expectation of strict adherence to predetermined process