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RN-Utilization Review-Managed Care-Contract

Job Description

  • Summary: Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing healthcare members with the right care at the right place at the right time.  Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review.  Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. Essential Functions: • Provides concurrent review and prior authorizations (as needed) according to policy for  members as part of the Utilization Management team. • Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures. • Participates in interdepartmental integration and collaboration to enhance the continuity of care formembers including Behavioral Health and Long Term Care. • Maintains department productivity and quality measures. • Attends regular staff meetings. • Assists with mentoring of new team members. • Completes assigned work plan objectives and projects on a timely basis. • Maintains professional relationships with provider community and internal and external customers. • Conducts self in a professional manner at all times.  • Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. • 



    Job Requirements

    -LPN or LVN required (Must be current and in good standing) 
    -1 year+ Hospital Utilization Management experience** 
    -1 year Clinical experience 
    -Managed care experience preferred 
    -Knowledge of Interqual 
    -Prior Authorization experience 
    -Computer literate (Microsoft Office) 
    -Excellent verbal communication 

    Abe Ghebrehiwet
    Senior Account Executive
    Nurse Resolutions
    888.411.2228. X 204 Toll Free
    407.982.7508. Fax
    [Click Here to Email Your Resumé]

    Job Snapshot

    Contact Name Abe Ghebrehiwet
    Contact Phone 888-411-2228 X 204
    Post Date 9/15/2014
    Location Columbus, OH
    Employment Type Full-Time
    Job Type Nurse, Insurance, Health Care
    Education Not Specified
    Experience Not Specified
    Manages Others Not Specified
    Industry Healthcare - Health Services, Managed Care
    Required Travel Not Specified
    Job ID abe
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