Utilization Review RN

Location: Des Moines, IA
Date Posted: 09-10-2018
CareNational
Utilization Review RN - Managed Care
Des Moines, IA
 
** This is a full-time, benefits available, CONTRACT opportunity, expected to last 3-4 months, or longer! **

Utilization Review Nurse Job Summary:
 
  • The Utilization Review Nurse is responsible for utilization management and utilization review for prospective (prior authorization), concurrent, or retrospective review.
  • The Utilization Review Nurse will performs reviews of services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
  • Utilize clinical skills to telephonically provide and facilitate utilization review, continued stay reviews and utilization management of all cases based on clinical experience and recognized guidelines.
  • The Utilization Review Nurse will obtain the information necessary to assess a member's clinical condition, identify ongoing clinical care needs and ensure that members receive services in the most optimal setting to effectively meet their needs.
 
Utilization Review Nurse Background:
 
  • Current, valid, and unrestricted state Registered Nurse (R.N.) license.
  • Bachelor degree and/or a CCM or CPHM /CPUM/CPUR or similar certification is preferred
  • At least 3 years of acute care clinical nursing experience is required.
  • Requires 1-2 years of recent experience in Utilization Review or Utilization Management at a health plan or other managed care organization (HMO/TPA/IPA/etc).
  • Knowledge of guidelines for Medicaid and related state programs is required.
  • Experience using Milliman or InterQual criteria for medical necessity, setting and level of care, and concurrent patient management.
  • Computer skills to include Microsoft Word, Excel, database use, and basic data entry.
 
#CLINICAL
 
AMANDA SOWARDS
SEARCH CONSULTANT
CareNational 
amanda@carenational.com
443.552.7423 (CALL – TEXT – FAX)
Schedule a time to talk by clicking HERE




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