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.Â Clinical reviews and continued stay authorizations will be documented in the appropriate electronic system.
Minimum Education:- Graduate of an accredited school of registered nursing.- BSN preferred.Minimum Experience/Knowledge:- Three years clinical experience.- One year case management or utilization review experience within the last three years preferred.Required License/Certification:- Valid California Registered Nurse license.- BLS Required.- Fire and Safety Certification. (If no card upon hire, one must be obtained within 30 days of hire, and maintained by renewal before expiration date.)
USC’s Viterbi School of Engineering has been one of the economic engines in Southern California and a vital hub in the California economy. The technical innovations and ideas generated by the Viterbi faculty and research community have resulted in countless innovations, many becoming the foundations for new companies, products and services. The thousands of students graduating each year bring new ideas and vitality to companies in California and beyond. With an annual research budget exceeding $205M each year, more than 46 research centers and institutes, more than 180 faculty members, 7,800 students and over 60,000 impassioned alumni world-wide, the Viterbi School is addressing some of the world’s great challenges.