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The Utilization Management/DRG Specialist is a Registered Nurse responsible for coordinating concurrent utilization management activities house-wide. The Utilization Management/DRG Specialist is the main link between the patient, health care team, organization, and payors during the patient’s hospital stay. The UM/DRG Specialist facilitates optimal reimbursement through accurate certification and complete chart documentation. Completes admission and continued stay reviews based on UR criteria. Assigns working DRG. Prompts documentation in chart to clarify diagnoses and medical necessity for admission and continued stay. This position participates in a collaborative team approach and works independently, as well as cooperatively and collaboratively with health care staff and management.
Utilization Management experience required.
BSN preferred, and current WA State RN License. Current certification is specialty field preferred.
Position focus will be on audits and PAD.
MultiCare is an equal opportunity employer that celebrates diversity at all levels of our organization. EOE/AA/M/F/D/V
MultiCare is a not-for-profit health care organization with more than 9,100 employees and a comprehensive network of services throughout...