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89e08fdf3427778a54d5d1d58ace4361

Registered Nurse

Collabera Nashville, TN Contractor
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******************************************************************************************

Industry: Health Care

Job Title: Registered Nurse

Duration: 4+ months with possibilities of extension

Work Hours: - Monday - Friday; 8am - 5pm

Location: Remote

 

***** Looking for someone with Registered Nurse Licenses with Utilization Management Experience *****

 

This is 100% remote and candidate can be located anywhere in the US. Must have RN license in corresponding state they will be working in. 

 

Remote Candidates - Must have reliable internet connection and experience working in a remote setting

 

·         The Utilization Management Review Nurse is responsible for assuring health care services are available to Medicare members in an appropriate cost-effective manner and delivery of those services to promote healthy outcome.

·         Responsibilities include collecting, analyzing, and evaluating clinical documentation received using established criteria to determine appropriateness of clinical decisions.

·         Adherence to all regulatory and departmental requirements in performing medical necessity reviews.

·         Responsible for the effective and sufficient support of all utilization management activities to include prospective concurrent/continued stay review of inpatient medical services for medical necessity and appropriateness of setting according to established policies.

·         Uses clinical knowledge, to analyze clinical data and apply evidence based criteria to determine the medical necessity of a treatment or service,

·         Process approval and adverse clinical determination correspondence for members related to Prospective request for services.

·         Perform clinical reviews with focus on improved medical outcomes.

·         Interact and participant with multiple members of the healthcare team both internally and externally

·         Interact with the Medical Director when unable to approve a request.

·         Ability to navigate multiple systems and applications.

·         Ability to review benefit plans, and additional clinical resources in order to properly evaluate services being requested.

·         Working knowledge of current health care practices and appropriate treatments Perform telephonic outreach to providers and members for additional information or completion of requested services.

·         Coordinate appropriate referrals to Case Management and/or other programs or services as required.

Skills: 

·         Excellent interpersonal and communications skills with peers, nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member

·         Ability to maintain and manage daily caseloads, and effectively adapt/respond to complex, fast-paced, rapidly growing, and results-oriented environments

·         Utilization Management Experience highly preferred

 

Education:    

·         Registered Nurse Required with 1-3 yrs experience in a Managed Care environment, and/or recent experience in an acute-care environment; or recent experience in utilization management position

 

*************************************************************************************

If you are interested and would like to discuss this position, please call me back at

973-598-3979
or email me at elvin.gohil[ Link removed ] - Click here to apply to Registered Nurse

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Recommended skills

Managed Care
Medicare
Utilization Management
Health Care
Nursing
Registered Nurse Certified
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