Why UnityPoint Health? 

Commitment to our Team – We’re proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members. 

Culture – At UnityPoint Health, you matter. Come for a fulfilling career and experience a culture guided by uncompromising values and an unwavering belief in doing what's right for the people we serve. 

Benefits – Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in. 

• Caring is what we do, and it starts with our team members: expect paid time off, parental leave, 401K matching and an employee recognition program as we support you both personally and professionally. 
• You can only give your best when you feel your best, and we help you live well with dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members to give you peace of mind. 
• We strive to make things easier and more personal in health care to set us apart from the rest, and you can experience that commitment through early access to earned wages with Daily Pay, a tuition reimbursement program designed to help you further your career and adoption assistance to help you grow your family in the way that works for you. 

Diversity, Equity and Inclusion Commitment – At UnityPoint Health, we honor the ways people are unique and embrace what brings us together. Our collective goal is to champion a culture of belonging where everyone feels valued and respected.  

Development – We believe equipping you with support and development opportunities is an essential part of delivering a remarkable employment experience. 

Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve. 

Hear more from our team members about why UnityPoint Health is a great place to work at  https://dayinthelife.unitypoint.org 

What are team member vaccine requirements?  

As part of keeping our communities safe and healthy, all team members must be vaccinated for influenza and Tdap, provide proof of immunity to MMR and varicella, and be tested for tuberculosis.  New hires must submit proof of vaccination or an approved exemption to begin work. If you have questions, please contact a recruiter or ask at any time during the interview process. UPH strongly recommends that all team members receive the updated COVID-19 vaccine, and at this time, UnityPoint Health – Meriter requires Covid-19 vaccination or an approved exemption. 

Location: Remote - Applicants preferrably reside in UnityPoint Health's geographical areas of IA, IL, and WI. 

Hours: Weekends--Rotating 8 hr days one weekend, 12 hour days the other weekend

The RN Utilization Management Specialist, under the direction of the Manager, Utilization Management serves a key role in coordinating the organization’s interdisciplinary effort to assess and effectively use organizational resources and to track and minimize the inappropriate use of such resources.   

• Performs utilization management admission and continued stay outpatient reviews using established criteria to confirm medical necessity, appropriate level of care and efficient use of resources. 

• Maximizes positive financial outcomes for patients and hospital by conducting timely ongoing chart review for hospitalized patients to monitor appropriateness of treatment, resource utilization, quality of care.   

• Applies utilization criteria using designated software to complete documentation related to utilization review activities in an accurate and timely manner for the purpose of providing information for other members of the healthcare team and to facilitate decision making. 

• Requests reviews with external and internal physician advisors as appropriate, if admission or continued stay criteria are not met, assuring appropriate and timely level of care status. 

• Applies accepted potentially avoidable day logic to reviews so that accurate and timely data collection may occur. 

• Serves as a resource to internal and external staff on issues related to utilization management 

• Maintains current knowledge of Utilization Review Methodology, software, criteria and regulations governing various payment systems. 

• Maintains current knowledge of the Unity Point Health Utilization Management Plan. 

• Maintains current knowledge of CMS rules (e.g. Code 44, A – B Rebilling, HINN, etc.)  and other regulatory agencies requirements to insure appropriate reimbursement. 

• Works with physicians regarding utilization issues as needed. 

• Provides information to Denials staff as requested 

• Professional communication – written & verbal 
• Microsoft Office proficiency (Outlook, Word, Excel) 
• Customer/patient focused 
• Self-motivated 
• Ability to work with minimal supervision 
• Ability to manage priorities/deadlines 
• Ability to multi-task and prioritize workload 
• Flexible and adaptable to changing environment 
• Excellent critical thinking and problem-solving skills 
• Positive attitude with team-oriented approach 
• Ability to give work direction to non-clinical staff 
• Use of usual and customary equipment used to perform essential functions of the position.