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Spectrum Health Utilization Review Specialist, RN (Priority Health) in Grand Rapids, Michigan

Facility: Priority Health - GRAND RAPIDS, MI

Department: Ph-Inpatient Util Mgmt

Category: Registered Nurse

Classification: Full-time with Benefits (A1)

Provides health information, interacts and acts as a resource for nursing units for complex clinical situations to ensure appropriate use of acute care services and diagnosis-related group (DRG) management. Assesses appropriateness of inpatient admissions and continued stay. Educates medical staff/other health care professionals regarding utilization management and quality requirements. Makes recommendations and provides financial and utilization management (UM) information to other members of the care facilitation teams for work prioritization. Works closely with inpatient care facilitators and Medical Social Workers to move patients through the continuum appropriately.

Basic Qualifications:

Education - Associate's Degree in Nursing

Experience - 2 years of relevant experience in acute care, clinical nursing, preferably multiple clinical settings, or related experience

Licenses -

Registered Nurse (RN)

Preferred Qualifications:

Education - Bachelor's Degree in Nursing

Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected category.