RN Utilization Review Nurse

Are you an experienced RN Utilization Review Nurse looking for a new opportunity with a prestigious healthcare company as a RN Utilization Review Nurse. Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the RN Utilization Review Nurse position for you!

Company Job Description/Day to Day Duties:

• Providing utilization review for the Medicaid and Medicare line of business. Primarily inpatient, skilled nurses facilities, rehab, behavioral health, and home healthcare.

• Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines

• Provider appeals and Utilization reviews and assist with Denial Letters
• Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization Management team.
• Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.
• Participates in interdepartmental integration and collaboration to enhance the continuity of care for members including Behavioral Health and Long Term Care.

Hours for this Position:

• Mon-Fri: 8:30am – 5pm

Advantages of this Opportunity:

• Great salary between $33 – 37!
• Great benefits!!!
• Fun and positive work environment!

Minimum Education/Qualifications/Licensures:

• Must be an RN
• Utilization Review background in either Managed Care of Provider environment (at least one year)
• Interqual experience (at least one year)
• Also has a background in patient, skilled nurses facilities, rehab, and home healthcare.
• Other basic computer skills necessary: Microsoft Office, Data Entry, etc.
• Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.
• Great typing and data entry skills

Interested in being considered?

If you are interested in being considered for this position, please click the apply button below.  Or call John Wood 407-478-0332 ext 225