logo

View All Opportunities

Utilization Review Nurse

Baltimore, MD · Healthcare
CONTRACT Utilization Review Nurse (RN or LPN) - Managed Care
Baltimore, MD
 
* Can start remotely due to COVID-19! *
*** This is a Full-Time, Benefits Available, CONTRACT opportunity, expected to last 3 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.) or License Practical Nurse (L.P.N.) license.
  • CCM or CPUR or similar certification is preferred
  • 2 years acute care clinical nursing experience is required.
  • 1 year 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/Medicare 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
JESSICA SUMMERS
SEARCH CONSULTANT
CareNational
jessica@carenational.com
480.429.4005 (CALL – TEXT – FAX)
See the latest @ CareNational Media!
 
Powered by