Utilization Review RN

Location: Brooklyn, NY
Date Posted: 09-12-2018
CareNational
Utilization Review RN - Managed Long Term Care (MLTC)
New York, NY (Brooklyn)
 
Utilization Review RN 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 RN Background: 
  • Valid, unrestricted state Registered Nurse (R.N.) license. 
  • Bachelor’s degree in Nursing (BSN) is required within 1 year of hire.
  • 2-4 years acute care clinical nursing experience.
  • At least 2-3 years of experience in a managed care organization, or two years acute inpatient hospital experience in chronic or complex care required. 
  • Experience in utilization review with strong cost containment/case management background preferred
  • Experience in utilization review with strong cost containment/case management background required. 
  • Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills required.  
  #Clinical
Erik Berg
SEARCH CONSULTANT
CareNational
erik@carenational.com
443.470.8240 (CALL – TEXT – FAX)
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