Job Description

Job Title: UM RN Reviewer
Job ID: 690496
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Department: GL HH Administration
Location: 1700 Peach St, Erie PA 16501


Provides direction and guidance to admission and clinical staff related to the overall functions of the Utilization Management department including but not limited to accurate, complete and compliant documentation.

  • Builds and mends relationships among colleagues within the framework of a healthy workplace
  • Role models keen cultural awareness including preventing and addressing horizontal violence and impairment
  • Maintains a conscious balance between work and personal life through prioritization and delegation of responsibilities.
  • Critically evaluate and provide direction and education related to utilization of services, diagnosis and teaching sheet selections on all comprehensive assessments
  • Review OASIS and 485 Plan of Care for accuracy and completeness and ensure correct coding assignment
  • Demonstrate knowledge of most recent COP's, PPS regulations and Joint Commission standards and ensure department compliance
  • Attend compliance training and adhere to the organization standards of conduct, policies and procedures
  • Identify, develop and participate in process improvement opportunities within the home health agency that will enhance the quality of the serviced provided
  • Identifies opportunities for clinical quality as well as workplace improvement
  • Applies evidence based practice as a regular aspect of professional practice
  • Serves on or leads teams that launch innovations in patient care or support a healthy workforce
  • Identify, investigate and recommend solutions to organization issues
  • Collaborate with clinical management to assist in identification and resolution of staff performance improvement areas and monitor and report upon progress


  • Graduate of accredited school of professional nursing required
  • BSN preferred
  • 2 years experience in home health required
  • 2 years utilization review experience preferred
  • Demonstrated proficiency in Medicare, Medicaid and commercial insurance regulations and in JCAHO standards required
  • Knowledge of ICD 9 coding required
  • Diagnostic coding experience preferred
  • OASIS experience preferred

Licensure, Certifications, and Clearances:
  • Act 33 Child Clearance
  • Act 34 Criminal Clearance
  • Act 34 Criminal Clearance
  • Older Adult Protective Services Act
  • Registered Nurse

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $19.25 to $33.33

Union Position: No

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