Utilization Review Nurse

Utilization Review Nurse NEEDED!

Insurance Overload Staffing is a corporate culture of insurance industry people who have dedicated themselves to serving the insurance industry through the providing of quality personnel services.  With over 26 years of experience in providing quality people, we know insurance and understand the abilities of the professionals in our industry!!!  IOS will work to find you the right position!!    

We currently have an immediate opening in Warwick, RI for a Utilization Review Nurse, as well as other insurance positions! 

Our Warwick client has a need for a Utilization Review Nurse to perform inpatient Utilization Review. Duties will include:  Review of medical records ; evaluate level of care; interact with MD's Case Managers; discharge planning.  Collect case information, review and certify the medical necessity of inpatient and outpatient services. Determine the most appropriate and cost efficient of care services. Provide clinical and managed care expertise, as well as Medical Director/physician consultation. Provide first level clinical review for all inpatient and outpatient services requiring authorization for assigned client group regarding: Prospective Review Urgent/ Non-urgent, Concurrent Review, Retrospective Review, Early initiation of discharge coordination, Analyze case-specific patient information. Verify eligibility, as applicable, and past utilization history. Evaluation case management and Second Surgical Opinion Review. Document pertinent information regarding individual reviews in SOAP format. Ensure timely notification of all parties (telephonic and/or written), as necessary, regarding certification recommendations. Handle caller requests addressed to other staff members; acts as a liaison assist the caller by routing to the appropriate person/ staff. Prepare case files for physician review via Physician Consultant Services or Medical director. This includes preparation of clinical information; correspondence. Function as a member of a self-directed team to meet specific individual and team performance metrics. Telephonic discussions with health care providers and members to explain medical necessity determinations and to obtain additional clinical information. Ensure consistent application of the utilization review process for all functional components. Document case review findings, actions, and outcomes in accordance with policy. Review clinical coverage reviews and assure client recommendations. Manage workload to ensure timely processing per state and federal mandates. Other duties as assigned.

Apply NOW to be seriously considered for this position, as well as other fantastic insurance opportunities that Insurance Overload Staffing has available.  We are always looking for good qualified insurance personnel such as Auto Adjusters, Workers’ Compensation Adjusters, Property Adjusters, Liability Adjusters, Casualty Adjusters, Underwriters, Underwriter Assistants, Commercial Lines CSR’s, Personal Lines CSR’s and many more!  We are a full service staffing firm with temp, temp-to-hire and direct hire positions!!

Insurance Overload Staffing demonstrates our appreciation and concern for our temporary employees with a COMPREHENSIVE BENEFIT PACKAGE providing medical, dental, vision, and life insurance, direct deposit, and MUCH, MUCH MORE!! 

Do NOT delay!!!  Don't send your resume to just anyone, contact the Professionals at Insurance Overload Staffing and GET ON THE FAST TRACK TO SUCCESS.... your future is waiting!!  To be considered for this or other exciting career opportunities, please visit our website at www.insuranceoverload.com and Pre-Register, if you have not already done so.  Also, be sure to attach a current resume. Let the IOS STAFF START WORKING FOR YOU!!