Teams at MultiCare Health System

The Utilization Management Specialist Nurse performs concurrent utilization review for a licensed facility, ensuring CMS-compliant admission and continued-stay reviews, certifications/authorizations, and accurate chart documentation. Serves as a clinical resource for UM staff, assists with complex case troubleshooting, and helps assign daily UM work to ensure timely, accurate reviews and optimal reimbursement.

Collect, coordinate, and accurately abstract clinical process and outcome data into databases. Ensure completeness and accuracy per agency guidelines and collaborate with program leadership on data collection.

Secure insurance eligibility and pre-authorizations for complex, high-dollar procedures and treatments. Verify benefits, validate referrals, submit and monitor authorization requests, review medical records, interpret payer policies and coding (CPT/HCPCS), communicate with providers, payers and patients, and meet productivity and accuracy standards to ensure financial clearance and uninterrupted patient care.