RN - Utilization Management (Insurance)

Recruitment Specialists, Inc

Hanover, MD

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JOB DETAILS

SKILLS

Acute Care, Communication Skills, Computer Skills, Denial of Service (DoS), Discharge Plans, Documentation Standards, Facilities Management, Health Plan Membership, Hospital, Image Management, Insurance, Interpersonal Skills, Managed Care, Negotiation Skills, Nursing, People Management, Presentation/Verbal Skills, Project/Program Management, Quality Metrics, Registered Nurse (RN), Utilization Management, Writing Skills

LOCATION

Hanover, MD

POSTED

16 days ago

Utilization Review Nurse (REMOTE)
Shift: Mon – Fri, 8:00am-5:00pm EST
WORK Location- REMOTE
(NO equipment will be issued. Traveler will need to use their own equipment)

Required:

Active MD or Compact RN License, (5) years RN experience,
Current UR experience;
EPIC experience preferred
Knowledge and use of Proficiency using InterQual criteria software systems,
Managed care experience in utilization review for at least 1 year preferred.

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, including acute hospitals, sub-acute hospitals, and acute rehabilitation facilities. The Utilization Nurse applies member benefit and medical criteria to determine authorization of services in coordination with the Medical Directors. The Utilization Nurse proactively initiates discharge planning for members, including identification of post-discharge needs and coordination of 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 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 collaborate with enrollees, Physicians, facility staff, and management staff. Work requires excellent interpersonal skills and attitude to effectively project a positive image of our Managed Care Program. Computer skills working with a variety of applications and online systems. Knowledge of Enterprise and utilizing various criteria sets i.e. InterQual. Ability to negotiate and resolve conflicts with external customers.

If you are interested in this position please submit and updated resume or give us a call.
Kayla (Walsh) Pollard
P: 410-825-6186 #2

RN - Utilization Management (Insurance)

Recruitment Specialists, Inc

Hanover, MD

About the Company

Recruitment Specialists, Inc

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