Registered Nurse – Utilization Management
Freelance
TELECOMMUTE – US National
02/15/24
The full Job description is on the original job post.
Registered Nurse – Utilization Management (REMOTE)
Job details
Salary:$24 – $42.00 per hour + Medical, Dental, Vision, PTO
United States of America
Job type: Contract
Discipline: Care Management
Reference:216356_1707170218
Work Remote
Job description
Registered Nurse – Utilization Management (REMOTE)
Medix Healthcare
Remote – RN License Compact (AZ/FL Required)
$38.00-$42.00 an hour – Full-time
Job Details
Salary
$38.00-$42.00 an hour
Job Type
Full-time
Qualifications
Active Registered Nurse License, Multi-State (AZ/FL Included)
3+ Years of Experience in Concurrent Review, Inpatient Services
3+ Years of Concurrent Review with a Health Plan
Strong Experience with InterQual and MGM Guidelines
Full Job Description
Are you a Registered Nurse that is looking to join an upcoming health plan dedicated to Medicare patients diagnosed with ESRD?We are looking to hire a Registered Nurse to support Utilization Management of both inpatient and outpatient services! This will provide assurance to our members that they are getting the access to treatments they require. Get your career started with us today by applying!
What we provide to you as a full-time teammate:
We offer a competitive benefits package that is on par with most of the leading healthcare organizations, along with a 401K plan. Apply today if you are interested in getting your name in the mix!
Requirements
Summary:The RN will utilize standard criteria to review pre-service requests and in-patient telephonic reviews in order to make determinations for approval based on criteria.
Essential Duties and Responsibilities:Include the following, other duties may be assigned.
As a Registered Nurse (Utilization Management), you will…
Conduct telephonic reviews for inpatient facilities for both concurrent and retrospective reviews for appropriateness of treatment setting reviews to ensure compliance with applicable criteria.
Process Prior Authorization requests for medical necessity of Outpatient services including Rehab, Home Health and DME.
Apply clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care.
Utilize evidence-based criteria that incorporates current and validated clinical research findings.
Practice within the scope of their license.
Provide care coordination for members who are transitioning from one level of care to another.
Gather clinical information to assess and expedite care needs.
Collaborate with providers to assess members, needs for early identification of and proactive planning for discharge, transfer and redirection.
Identify barriers to efficient utilization and facilitate resolution.
Collaborate with other departments to resolve claims, quality of care, member or provider issues.
Identify problems or needed changes, recommends resolution, and participates in quality improvement efforts.
Maintain and enhance relationships between the business and the provider community.
Provide consistent and accurate documentation.
Plan, organize and prioritize assignments to comply with performance standards, corporate goals, and established timelines.
Consult with physician advisors to ensure clinically appropriate determinations.
Expectations of Performance:The employee in this role shall be considered to be performing in an acceptable manner when carrying…
Nursing , Medical & Health , Case Management
Click here to apply! https://jobs.medixteam.com/job/registered-nurse-utilization-management-remote?source=jct.bold.com