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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.

Minimum Education:•Graduate of an accredited school of registered nursing. BSN preferred. Minimum Experience/Knowledge:•Three years clinical experience. Two years utilization review experience in an acute hospital setting required.Required License/Certification:•Valid California Registered Nurse license. BCLS 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. The hourly rate range for this position is $47.31 - $88.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

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