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Concurrent Review/ Utilization management Nurse

Integrated Resources, Inc Jacksonville Contractor
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Duration: 3-4+ Months
Anywhere in Florida, with occasional travel

Concurrent Review for Medicate Utilization Management.

Job Description: Job Duties include but are not limited to the following:

•Evaluate members in the Acute Hospital, LTAC, Acute Inpatient Rehab and/or Skilled Nursing Facility for benefit determination, medical necessity and appropriate level of care
•Participate in weekly case review
•Plan, implement, coordinate and monitor care coordination activities that focus on acute and non-acute services, outpatient services and or community resources for
•Monitor member's discharge status, identify and coordinate any additional needs or services for successful discharge/transition in care
•Collaborate with Medical Directors, Managers, Peers and other departments (e.g. Case Management)
•Responsibilities are not all inclusive (e.g., project work may be requested in addition to other responsibilities)
•Moderate to heavy keying required.

Job Requirements:
•Current Florida RN license
•2+ years of recent (within the past 3-5 years) clinical experience in a Hospital, LTAC, Rehab, SNF setting evaluating hospital benefit determination, medical necessity and appropriate level of care, esp. Utilization Management
•Experience in one or more of the following: Utilization Review, Discharge Planning or Case Management
•Experience with the Healthcare industry and Managed Care
•Proficient in MS Word, Excel and multiple computer applications
•Knowledge of NCQA/CMS Standards
•InterQual/MCG (Milliman) Care Guidelines
•Occasional travel within the State of Florida

Business Specific Criteria (preferred skills):
Bachelor's degree in related field (i.e. Nursing, Healthcare, Business)
Case Management Certification (CCM)

Recommended skills

Utilization Management
Managed Care
Medical Necessity
Nursing Home Care
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Job ID: 19-11621


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