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Utilization Management & Review Specialist

OSF Healthcare

OSF Healthcare

Peoria, IL, USA
USD 33.91-51.04 / hour
Posted on May 2, 2025

Job Description

Total Rewards

"Your life - our Mission"

OSF HealthCare is dedicated to provide Mission Partners with a comprehensive and market-competitive total rewards package that includes benefits, compensation, recognition and well-being offerings that focus on the whole person and engage with their current stage of life and career. Click here to learn more about benefits and the total rewards at OSF.

Pay range for this position is $33.91 - $51.04/hour. Actual pay is based on years of licensure. This is a Salaried position.


Overview

POSITION SUMMARY: The Utilization Management and Review Specialist (UMR Specialist) evaluates patient care and activities against objective criteria in an effort to take a proactive approach in addressing appropriate admission status of each patient. In addition the UMR Specialist will identify utilization issues involving under or over utilization of services, resolves and/or refers utilization issues in accordance with established procedures. Reviews medical records to determine appropriateness and medical necessity of admission and hospital stay and use of ancillary services.

The first 6 months is required to work on-site, at that time then it will be up to leadership discretion based on performance if the nurse can work remotely & would like to do so.


Qualifications

REQUIRED QUALIFICATIONS:

  • Education: Bachelor's Degree in Nursing must be obtained within 3 years of date of hire into role.
  • Experience: 2 years of clinical experience in an acute care or managed care setting
  • Licensure/Certifications: Current state license as Registered Nurse
  • Other skills/knowledge: Working knowledge of clinical EMR system

PREFERRED QUALIFICATIONS:

  • Education: Bachelor's Degree in Nursing
  • Other Skills/Knowledge: Working knowledge of Microsoft Office applications

OSF HealthCare is an Equal Opportunity Employer.