Registered Nurse

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Industry: Health Care

Job Title: Registered Nurse

Duration: 4+ months with possibilities of extension

Work Hours: - Monday - Friday; 8am - 5pm

Location: Remote

***** Looking for someone with Registered Nurse Licenses with Utilization Management Experience *****

This is 100% remote and candidate can be located anywhere in the US. Must have RN license in corresponding state they will be working in.

Remote Candidates - Must have reliable internet connection and experience working in a remote setting

• The Utilization Management Review Nurse is responsible for assuring health care services are available to Medicare members in an appropriate cost-effective manner and delivery of those services to promote healthy outcome.

• Responsibilities include collecting, analyzing, and evaluating clinical documentation received using established criteria to determine appropriateness of clinical decisions.

• Adherence to all regulatory and departmental requirements in performing medical necessity reviews.

• Responsible for the effective and sufficient support of all utilization management activities to include prospective concurrent/continued stay review of inpatient medical services for medical necessity and appropriateness of setting according to established policies.

• Uses clinical knowledge, to analyze clinical data and apply evidence based criteria to determine the medical necessity of a treatment or service,

• Process approval and adverse clinical determination correspondence for members related to Prospective request for services.

• Perform clinical reviews with focus on improved medical outcomes.

• Interact and participant with multiple members of the healthcare team both internally and externally

• Interact with the Medical Director when unable to approve a request.

• Ability to navigate multiple systems and applications.

• Ability to review benefit plans, and additional clinical resources in order to properly evaluate services being requested.

• Working knowledge of current health care practices and appropriate treatments Perform telephonic outreach to providers and members for additional information or completion of requested services.

• Coordinate appropriate referrals to Case Management and/or other programs or services as required.

Job Requirements:

Skills:

• Excellent interpersonal and communications skills with peers, nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member

• Ability to maintain and manage daily caseloads, and effectively adapt/respond to complex, fast-paced, rapidly growing, and results-oriented environments

• Utilization Management Experience highly preferred

Education:

• Registered Nurse Required with 1-3 yrs experience in a Managed Care environment, and/or recent experience in an acute-care environment; or recent experience in utilization management position

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If you are interested and would like to discuss this position, please call me back at 973-598-3979 or email me at elvin.gohil@collabera.com

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