Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare 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.
Duties:
Complete face to face visits with members in case management and as directed by the case manager. This role requires driving to multiple locations in a given day and will cover multiple counties. Case Manager will provide the series of questions that need to be asked. The goal is to educate members on their benefits and advise them on how they are utilize them to their fullest potential. Hands off care, more observing and documenting through computer. Candidate must be a self-starter.
Must Haves:
Required Education:
Completion of an accredited Registered Nursing program. (a combination of experience and education will be considered in lieu of Registered Nursing degree).
Required Experience:
Minimum 0-2 years of clinical practice. Preferably hospital nursing, utilization
Required Licensure /Certification: Active, unrestricted State Nursing (LPN) license in good standing.
All your information will be kept confidential according to EEO guidelines.
Job details are sourced from the employer's original posting.
Open job postingAbout the company
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.