Acute Care, Communication Skills, Denial of Service (DoS), Discharge Plans, Documentation Standards, Facilities Management, Health Plan Membership, Hospital, Image Management, Interpersonal Skills, Managed Care, Negotiation Skills, Nursing, People Management, Presentation/Verbal Skills, Project/Program Management, Quality Metrics, Registered Nurse (RN), Utilization Management, Writing Skills
Shift: Mon – Fri, 8:00am-5:00pm EST
WORK Location- REMOTE, No Call. holiday or weekend
8- week contract
Requirements of the UR Nurse-- Must be a MD or Compact RN
- Current experience with Utilization review and InterQual criteria required
- Managed care experience required
- Epic experience preferred
*NO equipment will be issued. Traveler will need to use their own equipment
Duties: Responsible for the day-to-day management of health confined plan members in acute care and/or rehabilitative facilities. The Utilization Nurse (UN) actively monitors the appropriateness of care received by plan members in a variety of settings, such as acute hospitals, sub-acute hospitals, and acute rehabilitation facilities. The Utilization Nurse applies member benefits and medical criteria to determine authorization of services in coordination with the Medical Directors. The Utilization Nurse proactively initiates discharge planning for members, including identifying post-discharge needs and coordinating post-discharge referrals/services. The UN communicates verbally and in writing authorization and/or denial of covered services with providers, facilities, and members. The UN is a member of the administrative and clinical teams in the area of assignment. Clinical knowledge is maintained and updated, and UN must maintain acceptable documentation and quality standards.
Skills: Excellent verbal and written communication skills to effectively interact and work correctly with enrollees, physicians, facility staff, and management staff. Work requires excellent interpersonal skills and an attitude to effectively project a positive image of our Managed Care Program. Ability to negotiate and resolve conflicts with external customers.
If you are interested in learning more, please submit an updated resume or give us a call.
Kayla (Walsh) Pollard
P: 410-825-6186 #2R
Recruitment Specialists, Inc