Utilization management (UM) specialists typically work in a hospital, clinic, or nursing home setting to ensure that all tasks and procedures are appropriate and necessary according to different health benefit plans.
UM specialists must be proficient with Microsoft Office software and comfortable reading large amounts of material filled with medical terminology. There are long periods of sitting and standing in this position, and these specialists usually work under a manager but interact regularly with patients, so strong interpersonal skills are necessary to provide good customer service. Depending on the nature of patient-interactions, protective clothing may be required to prevent the spread or contraction of infectious disease.
Requirements for this position can vary by employer, and some facilities provide on-the-job training. A high school diploma is a minimum requirement, and some employers prefer those who have a bachelor's degree in nursing and prior experience.
Utilization Management (UM) Specialist Tasks
Observe nurses and visit patients to ensure proper nursing care.
Interview or correspond with physicians to correct errors or omissions and to investigate questionable claims.
Consult and coordinate with health care team members to assess, plan, implement and evaluate patient care plans.