Utilization Review Specialist

Job description

Overview Be inspired. Be rewarded. Belong. At Emory Healthcare. At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: - Comprehensive health benefits that start day one! - Student Loan Repayment Assistance & Reimbursement Programs - Family-focused benefits - Wellness incentives - Ongoing mentorship, development, and leadership programs… and more! Description: The Utilization Review (UR) Specialist is a Registered Nurse responsible for conducting thorough medical necessity reviews to assist with determining appropriate patient class designation. The UR Specialist will perform timely and comprehensive reviews of the patient chart utilizing InterQual Criteria accurately in conjunction with the UR Department workflows/processes, clinical nursing judgement, and when necessary, discussions with the provider team and/or Medical Director of UR. Operational Support: 1. Conducts thorough medical necessity reviews to assist with determining appropriate patient class...