Utilization Management Specialist, Ed (rn Required) - Hybrid
publicsafety.vanderbilt.edu
Nashville, Tennessee, United States
Utilization review medical necessity criteria
Certification and denial processes
Interqual level of care criteria mastery
Vanderbilt University Medical Center is committed to advancing health and wellness through preeminent programs in patient care, education, and research
Job Summary
Vanderbilt University Medical Center is committed to advancing health and wellness through preeminent programs in patient care, education, and research.
The role facilitates optimal reimbursement through accurate certification and complete chart documentation ensuring appropriate admission status and level of care.
Employees enjoy benefits such as affordable health plans, retirement plans, paid time off, tuition reimbursement, and supplemental pay programs.
Matching Summary
Vanderbilt University Medical Center is committed to advancing health and wellness through preeminent programs in patient care, education, and research.
Skills & Requirements
Must-have
Utilization review medical necessity criteria
Certification and denial processes
InterQual Level of Care Criteria mastery
Clinical review for payor authorization
Collaboration with multidisciplinary teams
Nice-to-have
Effective communication skills
Problem solving and decision making
Training and educating others
Adaptability to change
Compassionate patient care
Key Requirements
Registered Nurse (RN) licensure
Bachelor's degree
Minimum 1 year relevant work experience
Knowledge of InterQual and Milliam Care Guidelines