Utilization Review RN
We are aggressively seeking Utilization Review RNs to join a large Healthcare organization. As the year 2017 is in full swing, this organization is very busy, and they need YOUR help.
Take advantage of flexible hours, a competitive salary, and be a Utilization Review RN with one of the fastest-growing healthcare companies in the U.S. Get in NOW, while there is still huge room for growth and career development!
This exciting opportunity will require a Utilization Review RN who can provide a high level of service and attention to their patients. If you are a Utilization Review RN and you meet the qualifications listed below, please click apply below for consideration
- The Utilization Review RN will be responsible for conducting Utilization Review of Initial Emergent Inpatient services and Continued Stay.
- The Utilization Review RN will be responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources.
- Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs, or community resources.
- Applies clinical knowledge to work with facilities and providers for care coordination.
- Works with medical directors in interpreting appropriateness of care and accurate claims payment.
- Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
- Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract.
- Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
- Collaborates with providers to assess member's needs for early identification of and proactive planning for discharge planning.
- Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.
- Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
- Clear and active RN license in IN
- 2 years of acute care clinical experience (Trauma, Emergency, Urgent Care, Critical Care, Short-term, Pre-hospital care)
- Strong background in Utilization Management (specifically around Initial Emergent Inpatient Review and Continued Stay Reviews)
- AS/BS in Nursing (or any combination of Edu/experience that would provide an equivalent background)
- Ability to multitask and adapt to change with a positive attitude
- Computer proficient
Hours for this Position:
Monday-Friday 8am-5pm with occasional Saturday rotation
Advantages of this Opportunity:
- Competitive salary, negotiable based on relevant experience ($30 - $34/hourly)
- Benefits offered, Medical, Dental, and Vision
- Fun and positive work environment
Interested in being Considered?
If you are interested in applying to this position, please click Apply Now or email your resume directly.
El Nino Bautista
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
Mon, 24 Apr 2017 08:33:24 PDT